Individual
TRE' ADDISON LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(931) 624-7808
Mailing address
1724 HAZELWOOD RD, CLARKSVILLE, TN 37042-8535
(931) 624-7808
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13768256-3501
UT
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/02/2019
Last updated
04/08/2024
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