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Paige Nicole Logan

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Clearlake Oaks, CA

NPI 1760160170 · NPPES record last updated Jul 6, 2023

Key facts

NPI
1760160170
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
SUDRC15712 (CA)
Practice address
14715 E Highway 20
Clearlake Oaks, CA 95423
Phone
(707) 998-1800
NPI assigned
Jul 6, 2023
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
SUDRC15712CAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Hilltop Recovery Services Past
since Jul 9, 2023		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X SUDRC15712 CA Yes

Addresses

Primary practice location

14715 E Highway 20
Clearlake Oaks, CA 95423

Mailing address

PO Box 316
Lucerne, CA 95458-0316
Phone (707) 274-5610

Other providers in Clearlake Oaks, CA

All providers in Clearlake Oaks, CA · Addiction (Substance Use Disorder) Counselor in California

Sources for this page

Verify at the official NPI Registry.