Individual
BETHANY LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1477 NC 24-87, CAMERON, NC 28326-6752
(910) 484-1711
Mailing address
568 SANDHURST DR, FAYETTEVILLE, NC 28304-4426
(910) 484-1711
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-320831
NC
Other
Enumeration date
01/09/2024
Last updated
01/09/2024
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