Individual
CHRYSTAL T LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
415 MAIN ST, WEST HAVEN, CT 06516-4296
(203) 931-1184
(203) 931-1184
Mailing address
415 MAIN ST, WEST HAVEN, CT 06516-4296
(203) 931-1184
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2045
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235918
—
CT
Enumeration date
07/08/2008
Last updated
04/06/2011
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