Provider Demographics
NPI:1114186343
Name:LONGINO, DANA (MS, LMFT, CADAC II)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:LONGINO
Suffix:
Gender:F
Credentials:MS, LMFT, CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 INDUSTRY WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262
Mailing Address - Country:US
Mailing Address - Phone:310-627-4525
Mailing Address - Fax:310-627-4531
Practice Address - Street 1:2640 INDUSTRY WAY
Practice Address - Street 2:SUITE B
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:310-639-5983
Practice Address - Fax:310-639-5870
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC8535004101YA0400X
CAMFT 18441106H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator