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Individual

LOGAN RENE NICKERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CADC

Contact information

Practice address
103 WOLF CREEK BLVD STE 2&3, DOVER, DE 19901-4967
(302) 744-8474
Mailing address
114 LOGAN DR, DOVER, DE 19901-1583
(302) 505-0384

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2346
DE

Other

Enumeration date
01/16/2025
Last updated
01/16/2025
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