Individual
DESTINY RENEA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5810 KINGSTOWNE CTR STE 921, ALEXANDRIA, VA 22315-5732
(207) 478-1951
Mailing address
3654 EDENBERRY CT, VIRGINIA BEACH, VA 23452-8208
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133002335
VA
106S00000X
Behavior Technician
RBT-19-91203
VA
Other
Enumeration date
07/09/2019
Last updated
04/15/2022
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