| NPI | 1245584473 |
|---|---|
| Former Name | AMBER RAYE LOGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 5968) |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2012-11-09 |