Provider Demographics
NPI:1922694181
Name:DUONG, LONG HAI (RBT)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:HAI
Last Name:DUONG
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10128 HUTZELL ST
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-8818
Mailing Address - Country:US
Mailing Address - Phone:301-906-0342
Mailing Address - Fax:
Practice Address - Street 1:10128 HUTZELL ST
Practice Address - Street 2:
Practice Address - City:IJAMSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21754-8818
Practice Address - Country:US
Practice Address - Phone:301-906-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician