Provider Demographics
NPI:1164310744
Name:LONG, MARIA WENONA (AMFT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:WENONA
Last Name:LONG
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 EUCALYPTUS HILL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2813
Mailing Address - Country:US
Mailing Address - Phone:805-452-5466
Mailing Address - Fax:
Practice Address - Street 1:138 E CARRILLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2111
Practice Address - Country:US
Practice Address - Phone:805-350-0517
Practice Address - Fax:805-855-0020
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist