Individual
AJASHA MAXINE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
14540 OLD SAINT AUGUSTINE RD STE 2591, JACKSONVILLE, FL 32258-7420
(904) 376-3800
(904) 390-7405
Mailing address
2500 METROHEALTH DR, CLEVELAND, OH 44109-1900
(314) 780-8699
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY12271
FL
103TC1900X
Counseling Psychologist
P.08309
OH
Other
Enumeration date
04/13/2020
Last updated
06/03/2024
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