Provider Demographics
NPI:1346610953
Name:LONG, CHINA (LMFT)
Entity Type:Individual
Prefix:
First Name:CHINA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27780 JEFFERSON AVE STE M
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2670
Mailing Address - Country:US
Mailing Address - Phone:951-694-0608
Mailing Address - Fax:951-694-4460
Practice Address - Street 1:27780 JEFFERSON AVE STE M
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2670
Practice Address - Country:US
Practice Address - Phone:951-694-0608
Practice Address - Fax:951-694-4460
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT80102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health