Organization
KIM LOGAN COMMUNICATIONS CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN O ANDERSON (OFFICE MANAGER)
(313) 664-4900
Entity
Organization
Contact information
Practice address
3011 W GRAND BLVD, SUITE 423, DETROIT, MI 48202-3096
(313) 664-4900
(313) 664-4901
Mailing address
3011 W GRAND BLVD, SUITE 423, DETROIT, MI 48202-3096
(313) 664-4900
(313) 664-4901
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401001940
MI
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC0700X
Clinical Psychologist
6301011558
MI
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
6801068236
MI
1041S0200X
School Social Worker
6301011558
MI
106H00000X
Marriage & Family Therapist
—
—
235Z00000X
Speech-Language Pathologist
12068248
MD
Other
Enumeration date
02/17/2011
Last updated
12/13/2016
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