Individual
GLENN B LONGIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
113 MAIN AVE E, ROLLA, ND 58367
(701) 477-8272
(701) 477-8281
Mailing address
PO BOX 650, DEVILS LAKE, ND 58301-0650
(701) 477-8272
(701) 477-8281
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1514
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054518
—
ND
Enumeration date
05/16/2007
Last updated
07/09/2007
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