Individual
BRYAN BALCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EXECUTIVE DIRECTOR
Contact information
Practice address
623 GREAT JONES ST, FAIRFIELD, CA 94533-6005
(707) 664-7798
Mailing address
623 GREAT JONES ST, FAIRFIELD, CA 94533-6005
(707) 664-7798
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11200
CA
Other
Enumeration date
09/20/2022
Last updated
09/20/2022
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