Individual
VINCE D LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SAC
Contact information
Practice address
100 COUNTY ROAD B, SHAWANO, WI 54166-7072
(715) 524-2161
Mailing address
100 COUNTY ROAD B, SHAWANO, WI 54166-7072
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16456-131
WI
101YM0800X
Mental Health Counselor
8859
WI
Other
Enumeration date
10/07/2021
Last updated
03/25/2026
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