Individual
JACINDA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 S DOBSON RD, MESA, AZ 85202-4707
(480) 710-1263
Mailing address
1156 E VINEDO LN, TEMPE, AZ 85284-1534
(480) 710-1263
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
AZ-16889
AZ
Other
Enumeration date
10/08/2021
Last updated
10/08/2021
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