| W. Michelle Long, Lcsw, Professional Limited Liability Company | |
|
502 E 2nd Ave Crestview FL 32536 | |
| (850) 547-6922 | |
| Not Available |
| Full Name | W. Michelle Long, Lcsw, Professional Limited Liability Company |
|---|---|
| Speciality | Social Worker |
| Location | 502 E 2nd Ave, Crestview, Florida |
| Authorized Official Name and Position | Wanda Michelle Long (LCSW) |
| Authorized Official Contact | 8505476922 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| W. Michelle Long, Lcsw, Professional Limited Liability Company 502 E 2nd Ave Crestview FL 32536 Ph: (850) 547-6922 | W. Michelle Long, Lcsw, Professional Limited Liability Company 502 E 2nd Ave Crestview FL 32536 Ph: (850) 547-6922 |
| NPI Number | 1366121840 |
|---|---|
| Provider Enumeration Date | 07/12/2023 |
| Last Update Date | 07/12/2023 |
| Certification Date | 07/12/2023 |
| Medicare PECOS PAC ID | 2466803143 |
|---|---|
| Medicare Enrollment ID | O20240106000285 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366121840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Wanda Michelle Long |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730661935 PECOS PAC ID: 9234476326 Enrollment ID: I20240106000308 |
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