Individual
LESTER LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1156 WOODLAND AVE NE, ATLANTA, GA 30324-4400
(404) 772-6757
Mailing address
1156 WOODLAND AVE NE, ATLANTA, GA 30324-4400
(404) 772-6757
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
044
GA
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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