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1750895298
TANISHA JORDAN BALOGUN
RIVERSIDE, CA
NPI
1750895298
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-11-20
Last Update Date
2017-11-20
Business Address
TANISHA JORDAN BALOGUN
17270 ROOSEVELT ST # 304
RIVERSIDE, CA 92508-9523
Phone number: 951-780-2541
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Mailing Address
TANISHA JORDAN BALOGUN
17270 ROOSEVELT ST # 304
RIVERSIDE, CA 92508-9523
Phone number: 951-780-2541
Copy
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