Individual
CARLENE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7544 W STACY DR, VENTRESS, LA 70783-3915
(225) 240-0928
Mailing address
7544 W STACY DR, VENTRESS, LA 70783-3915
(225) 240-0928
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000
—
LA
Enumeration date
03/13/2018
Last updated
06/16/2018
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