Individual
MICHAEL JOSEPH LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
515 COLUMBIA AVE # 200, LOS ANGELES, CA 90017-1209
(213) 249-9388
(213) 489-7993
Mailing address
515 COLUMBIA AVE # 200, LOS ANGELES, CA 90017-1209
(213) 249-9388
(213) 489-7993
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
34981
CA
Other
Enumeration date
04/29/2013
Last updated
12/01/2020
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