Individual
MR. WILLARD TRUMAN LONG JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW LGSW LCSWA
Contact information
Practice address
410 FERRY ST, MONTGOMERY, WV 25136
(304) 553-6218
Mailing address
7410 CHICKADEE CT, SANFORD, NC 27332-8810
(910) 824-0608
(910) 466-9001
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
BP02940160
WV
1041C0700X
Clinical Social Worker
Primary
P013072
NC
Other
Enumeration date
08/04/2016
Last updated
03/12/2020
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