Basic Information
| Provider Information | |||||||||
| NPI: | 1114186343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONGINO | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S., LMFT, CADAC II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2640 INDUSTRY WAY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106274525 | ||||||||
| FaxNumber: | 3106274531 | ||||||||
| Practice Location | |||||||||
| Address1: | 2640 INDUSTRY WAY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106395983 | ||||||||
| FaxNumber: | 3106395870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 02/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | C8535004 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | MFT 18441 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.