Individual
MRS. CHRISTINE DIANNE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1904 RICHLAND AVE, CERES, CA 95307-4562
(209) 541-2121
Mailing address
1904 RICHLAND AVE, CERES, CA 95307-4562
(209) 541-2121
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
374700000X
Technician
Primary
—
—
Other
Enumeration date
04/01/2013
Last updated
08/16/2013
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