Provider Demographics
NPI:1437731429
Name:SOHMA, LOGAN ALEXANDER (CDCA, CPRS)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:ALEXANDER
Last Name:SOHMA
Suffix:
Gender:M
Credentials:CDCA, CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-3602
Mailing Address - Country:US
Mailing Address - Phone:216-762-1237
Mailing Address - Fax:
Practice Address - Street 1:1804 E 55TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3602
Practice Address - Country:US
Practice Address - Phone:216-762-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0002265175T00000X
OHCDCA.183452101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist