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1053825414
ISAIAH LOGAN
CERES, CA
NPI
1053825414
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-11-21
Last Update Date
2017-11-21
Business Address
Mr. ISAIAH LOGAN
1904 RICHLAND AVE
CERES, CA 95307-4562
Phone number: 209-541-2121
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Mailing Address
Mr. ISAIAH LOGAN
1904 RICHLAND AVE
CERES, CA 95307-4562
Phone number:
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