Provider Demographics
NPI:1174716377
Name:LONGWILL, VICKIE (LCDC, ADC III, ICADC)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:
Last Name:LONGWILL
Suffix:
Gender:F
Credentials:LCDC, ADC III, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 NORTH LOOP WEST
Mailing Address - Street 2:SUITE 335
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8127
Mailing Address - Country:US
Mailing Address - Phone:713-628-2980
Mailing Address - Fax:713-681-3800
Practice Address - Street 1:2040 NORTH LOOP WEST
Practice Address - Street 2:SUITE 335
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8127
Practice Address - Country:US
Practice Address - Phone:713-628-2980
Practice Address - Fax:713-681-3800
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2070101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115651OtherTHE INTERNATIONAL CERTIFICATION & RECEPROCITY CONSORTIUM
TX2070OtherDEPARTMENT OF STATE HEALTH SERVICES
TX9551-0991OtherTEXAS CERTIFICATION BOARD OF ADDICTION PROFESSIONALS