Individual
BREANNA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30 S 4TH ST, NEWARK, OH 43055-5002
(380) 201-1313
Mailing address
30 S 4TH ST, NEWARK, OH 43055-5002
(380) 201-1313
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
02/21/2022
Last updated
03/06/2024
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