Individual
PENNY KATHLEEN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDPT
Contact information
Practice address
121 NW CHEHALIS AVE, CHEHALIS, WA 98532-2010
(360) 740-9767
Mailing address
121 NW CHEHALIS AVE, CHEHALIS, WA 98532-2010
(360) 740-9767
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
60804582
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60804582
DEPT OF HEALTH
WA
Enumeration date
09/13/2018
Last updated
09/13/2018
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