Individual
TIA LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
423 SEMINARY ST, NAPA, CA 94559-3214
(707) 927-3296
Mailing address
423 SEMINARY ST, NAPA, CA 94559-3214
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
33107
CA
Other
Enumeration date
11/11/2024
Last updated
11/11/2024
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