Individual
ROGER D VIRGIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1443 IDAHO ST, LEWISTON, ID 83501-2558
(208) 827-2524
Mailing address
1720 18TH AVE, LEWISTON, ID 83501-4047
(208) 746-4097
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13035
ID
Other
Enumeration date
02/06/2024
Last updated
02/06/2024
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