Individual
MS. DIANE MARIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
750 FRONT ST NE, SALEM, OR 97301-1089
(503) 363-2021
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
(541) 476-1526
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/14/2011
Last updated
12/15/2022
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