Provider Demographics
NPI:1205222064
Name:LONG, DEANA M (BA, CADC II, ICADC)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:M
Last Name:LONG
Suffix:
Gender:F
Credentials:BA, CADC II, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RIVER ROCK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-1093
Mailing Address - Country:US
Mailing Address - Phone:530-863-8522
Mailing Address - Fax:
Practice Address - Street 1:1000 RIVER ROCK DR STE 106
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-1093
Practice Address - Country:US
Practice Address - Phone:530-863-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA021141115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)