Organization
DIANE LOGAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE E LOGAN PHD, CSAC (OWNER)
(808) 437-7447
Entity
Organization
Contact information
Practice address
75-127 LUNAPULE RD STE 15B, KAILUA KONA, HI 96740-2119
(808) 437-7447
(808) 374-9046
Mailing address
PO BOX 5488, KAILUA KONA, HI 96745-5488
(808) 437-7447
(808) 374-9046
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
03/20/2020
Last updated
10/06/2021
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