Individual
LACEY LYNN LONGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1311 N 1720TH AVE, FOWLER, IL 62338-1016
(217) 506-2788
Mailing address
1390 MARKET ST STE 200, SAN FRANCISCO, CA 94102-5404
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CADC-45328
IL
Other
Enumeration date
11/17/2025
Last updated
11/19/2025
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