Individual
LISA C LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1035 CHERAW ST, BENNETTSVILLE, SC 29512
(843) 454-0442
(843) 454-0212
Mailing address
PO BOX 918, BENNETTSVILLE, SC 29512
(843) 454-0841
(843) 454-0635
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
212783
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405127
—
SC
Enumeration date
03/18/2010
Last updated
03/18/2010
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