Individual
AMANDA BALES LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1800 MICHAEL FARADAY DR STE 206, RESTON, VA 20190-5312
(703) 935-0058
Mailing address
3483 LYON PARK CT, WOODBRIDGE, VA 22192-1022
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904010519
VA
Other
Enumeration date
06/14/2018
Last updated
06/14/2018
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