ETIENNE FOX LOGAN

SUFFOLK, VA
NPI1346712478
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: VA  0732005011)
Enumeration Date2018-12-31
Last Update Date2018-12-31
Business Address
ETIENNE FOX LOGAN
1258 HOLLAND RD
SUFFOLK, VA 23434-6313
Phone number: 757-809-4771
Mailing Address
ETIENNE FOX LOGAN
55 BEATTIE PL STE 810
GREENVILLE, SC 29601-2191
Phone number: 864-527-3145
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