Individual
ELIZABETH LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5439 BURKHARDT RD, DAYTON, OH 45431-2111
(937) 791-1440
Mailing address
928 CROYDON CT, VANDALIA, OH 45377-1615
(937) 367-2516
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C2204215
OH
390200000X
Student in an Organized Health Care Education/Training Program
C2103225-TRNE
OH
Other
Enumeration date
05/14/2021
Last updated
05/07/2025
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