Rewire the Misfire, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

REWIRE THE MISFIRE, LLC

Practice address

121 Carl Vinson Pkwy
Warner Robins, GA 31088-5817

Phone

(478) 216-8555

NPI assigned

Jan 3, 2022

Last updated

Jan 3, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Delvida Long, PHDNPI 1871543736

Title

Psychologist

Phone

(478) 216-8555

Specialties & licenses 2

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Delvida L. Long, PH.D.

  • Clinical Psychologist
  • Robins AFB, GA
  • NPI 1871543736
  NPD Authorized official
• Kimberly Marketto, LCSW

  • Social Worker
  • Robins AFB, GA
  • NPI 1437551900
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641168000000",
    "number": "1336800283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 FOREST POINTE",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310887527",
            "telephone_number": "478-216-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 CARL VINSON PKWY",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310885817",
            "telephone_number": "478-216-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REWIRE THE MISFIRE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-03",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "DELVIDA",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "478-216-8555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Warner Robins, GA
• Providers in Warner Robins, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.