Organization
REWIRE THE MISFIRE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DELVIDA LONG PHD (PSYCHOLOGIST)
(478) 216-8555
Entity
Organization
Contact information
Practice address
121 CARL VINSON PKWY, WARNER ROBINS, GA 31088-5817
(478) 216-8555
Mailing address
102 FOREST POINTE, WARNER ROBINS, GA 31088-7527
(478) 216-8555
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
01/03/2022
Last updated
01/03/2022
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