Individual
MS. MARY CALLAWAY LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, M.DIV., FELLOW
Contact information
Practice address
1200 PONCE DE LEON AVE NE, ATLANTA, GA 30306-4602
(404) 931-6395
Mailing address
1200 PONCE DE LEON AVE NE, ATLANTA, GA 30306-4602
(404) 931-6395
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
000758
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000758
LICENSED PROFESSIONAL COU
GA
Enumeration date
05/22/2007
Last updated
07/08/2007
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