Provider Demographics
NPI:1902682727
Name:FOX-LONG, ROSE CHARLOTTE (LLMSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:CHARLOTTE
Last Name:FOX-LONG
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 UNIVERSITY PARK DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-5956
Mailing Address - Country:US
Mailing Address - Phone:517-243-9738
Mailing Address - Fax:517-940-4863
Practice Address - Street 1:2157 UNIVERSITY PARK DR
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5956
Practice Address - Country:US
Practice Address - Phone:517-243-9738
Practice Address - Fax:517-940-4863
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511170011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical