Provider Demographics
NPI:1215131636
Name:LONG, MARCIA GAIL (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:GAIL
Last Name:LONG
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:M GAIL
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:3980 MILL ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3951
Mailing Address - Country:US
Mailing Address - Phone:541-510-0009
Mailing Address - Fax:541-654-5489
Practice Address - Street 1:1001 WASHINGTON ST
Practice Address - Street 2:SUITE 8
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3419
Practice Address - Country:US
Practice Address - Phone:541-510-0009
Practice Address - Fax:541-654-5489
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL47321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical