Individual
GREGORY LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
1400 W NORTHWEST HWY, 260, GRAPEVINE, TX 76051-8113
(817) 319-9962
Mailing address
1400 W NORTHWEST HWY, 260, GRAPEVINE, TX 76051-8113
(817) 319-9962
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11080
TX
Other
Enumeration date
03/02/2014
Last updated
03/02/2014
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