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Organization
NANCY LOGAN DETWEILER LCSW
Active
Organization
NANCY LOGAN DETWEILER LCSW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY LOGAN DETWEILER LCSW (OWNER)
(352) 338-1321
Entity
Organization
Contact information
Practice address
4830 NW 43RD ST, GAINESVILLE, FL 32606-4401
(352) 338-1321
(352) 376-3872
Mailing address
4830 NW 43RD ST, C45, GAINESVILLE, FL 32606-4600
(352) 338-1321
(352) 376-3872
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW859
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11403345
PISO
—
05
—
1780727149
—
FL
Enumeration date
11/09/2017
Last updated
11/09/2017
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