ROGER D VIRGIN

LEWISTON, ID
NPI1144084617
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: ID  13035)
Enumeration Date2024-02-06
Last Update Date2024-02-06
Business Address
ROGER D VIRGIN
1443 IDAHO ST
LEWISTON, ID 83501-2558
Phone number: 208-827-2524
Mailing Address
ROGER D VIRGIN
1720 18TH AVE
LEWISTON, ID 83501-4047
Phone number: 208-746-4097
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