Individual ProviderCharles Anthony LongMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address5480 Baltimore Dr, Suite 202, La Mesa, CA 91942(619) 462-0199PECOS EnrollmentBased on the most recent information from CMS, provider Charles Anthony Long does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1740271337Provider TypeIndividualFull NameLong, Charles AnthonyTitleMr.CredentialMFTGenderMaleSole ProprietorYesEnumeration Date11/2/2005Last Updated11/25/2024Contact InformationPractice LocationPractice Address5480 Baltimore Dr, Suite 202, La Mesa, CA 91942Phone(619) 462-0199Fax(619) 464-7772Mailing LocationMailing Address5480 Baltimore Dr, Suite 202, La Mesa, CA 91942Phone(619) 462-0199Fax(619) 464-7772Provider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseMFC33504CaliforniaCode106H00000XDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense33504California