Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 0810004025 | VA |
N | 103TC0700X | Clinical Psychologist | 0810004025 | VA |
Y | 102L00000X | Psychologist | 0810004025 | VA |
Y | 103T00000X | Psychologist | 0810004025 | VA |
N | 103TH0004X | Health Psychologist | 0810004025 | VA |
N | 103TR0400X | Rehabilitation Psychologist | 0810004025 | VA |
NPI | 1598124638 |
---|---|
Provider Name | Dr. Clio Long |
First Address | Alexandria, VA 22306-3404 |
Second Address | Alexandria, VA 22306-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2016 |
Last Update Date | 17/02/2016 |