Individual
LEA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-PIP
Contact information
Practice address
4400 W 69TH ST STE 100, SIOUX FALLS, SD 57108-8172
(605) 322-4008
(605) 322-4009
Mailing address
4400 W 69TH ST, SIOUX FALLS, SD 57108-8170
(605) 322-4008
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
5128
SD
Other
Enumeration date
11/16/2021
Last updated
11/16/2021
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