Provider Demographics
NPI:1376096438
Name:LONG, EVELYN MARIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:MARIE
Last Name:LONG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:54 RAINIER GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-9645
Mailing Address - Country:US
Mailing Address - Phone:360-580-8984
Mailing Address - Fax:360-532-9933
Practice Address - Street 1:224 E WISHKAH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6513
Practice Address - Country:US
Practice Address - Phone:360-580-8984
Practice Address - Fax:360-532-9933
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60160310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health