Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1174836654 |
---|---|
Provider Name | Lennie Long |
First Address | Waipahu, HI 96797-3671 |
Second Address | Pearl City, HI 96782-1478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 26/07/2010 |