Individual
NIKITA LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 E ALEXANDER ST, LAFAYETTE, LA 70501-2304
(832) 687-2771
Mailing address
PO BOX 62498, LAFAYETTE, LA 70596-2498
(832) 687-2771
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10035
LA
Other
Enumeration date
01/05/2016
Last updated
01/05/2016
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