Provider Demographics
NPI:1689062747
Name:LONG, ALLISON JEANNE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JEANNE
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:JEANNE
Other - Last Name:ANNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:482 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-3611
Mailing Address - Country:US
Mailing Address - Phone:941-275-4796
Mailing Address - Fax:
Practice Address - Street 1:2055 WOOD ST
Practice Address - Street 2:SUITE 118
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7903
Practice Address - Country:US
Practice Address - Phone:941-955-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health