| NPI | 1255679718 |
|---|---|
| Former Name | JESSICA L LOGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 1787) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 9923373) |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2021-05-10 |