Provider Demographics
NPI:1972150514
Name:DE LONG, TAMMI SUZANNE (AOD)
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:SUZANNE
Last Name:DE LONG
Suffix:
Gender:F
Credentials:AOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24631 MEADOW CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9668
Mailing Address - Country:US
Mailing Address - Phone:209-642-1367
Mailing Address - Fax:
Practice Address - Street 1:1947 N CALIFORNIA ST STE B&C
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6029
Practice Address - Country:US
Practice Address - Phone:209-463-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)