MARY M LONG, LCPC, MAC, Professional APO, AE

Contact Information

MARY M LONG, LCPC, MAC

AVENUE D'OSLO BLDG 401
UNIT 21420
APO, AE 09705

Phone: 314-566-5320
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Professional	101YP2500X
Addiction (Substance Use Disorder)	101YA0400X

Indicates primary specialty

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NPI Profile & details for MARY M LONG · (Female)

NPI Number	`1629102124`
Status	Active
Credentials	LCPC, MAC
Entity	Individual
Enumeration date	03/15/2007
Last updated	07/20/2021 - About 5 years ago
Sole proprietor ¹	No
Identifiers	License # 501904 ID License # LCPC-3666 ID Medicaid 002269500 ID Other Q7358 BLUE CROSS OF IDAHO ID Other 000010146797 REGENCE BLUE SHIELD
Hospital affiliation(s)	Not Available

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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MARY M LONG, LCPC, MAC – NPI #1629102124Professional

Contact Information

Specialty

Professional

Addiction (Substance Use Disorder)

NPI Profile & details for MARY M LONG · (Female)

Reviews for MARY M LONG

MARY M LONG, LCPC, MAC – NPI #1629102124
Professional