Individual
MRS. MARGE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C3618-A
Contact information
Practice address
603 37TH ST S, BIRMINGHAM, AL 35222-3203
(205) 470-3109
Mailing address
603 37TH ST S, BIRMINGHAM, AL 35222-3203
(205) 470-3109
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
CG60768436
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG60768436
WA DOH
WA
Enumeration date
06/12/2017
Last updated
02/25/2022
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