Individual
MR. JUSTIN DAVID LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1160 LIBERTY ST SE, SALEM, OR 97302-4143
(503) 979-8151
Mailing address
1525 PARKSIDE CT NE, KEIZER, OR 97303-7704
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Enumeration date
03/19/2024
Last updated
03/19/2024
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