Individual provider · Type 1 NPI

Etienne Fox Logan Ii

Addiction (Substance Use Disorder) Counselor · Suffolk, VA

NPI number 1346712478 Active

Practice location

1258 Holland Rd
Suffolk, VA 23434-6313

Call (757) 809-4771 Map

Fax (757) 809-4932

Mailing address

55 Beattie Pl Ste 810
Greenville, SC 29601-2191

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X0732005011 (VA)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1346712478

Etienne Fox Logan Ii's National Provider Identifier is 1346712478, issued on Dec 31, 2018. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Suffolk, VA. The record was last updated on Dec 31, 2018.