Individual
OCTAVIS LAQUAN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
715 BUTEO DR, EAST LANSING, MI 48823-8304
(517) 614-5200
Mailing address
715 BUTEO DR, EAST LANSING, MI 48823-8304
(517) 614-5200
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361002091
MI
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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