Individual
LOGAN NICOLETTE MASSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 PALENCIA VILLAGE DR # C-105164, ST AUGUSTINE, FL 32095-8549
(904) 201-9129
(615) 694-3915
Mailing address
120 PALENCIA VILLAGE DR, ST AUGUSTINE, FL 32095-8549
(904) 201-9129
(615) 694-3915
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
10/19/2017
Last updated
11/08/2022
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