Individual
MICHELLE MARIE LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
1062 STATE ROUTE 38, OWEGO, NY 13827
(607) 687-4000
(607) 687-6396
Mailing address
8 N. CHEMUNG ST., WAVERLY, NY 14892
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19014
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19014
CASAC
NY
Enumeration date
09/21/2006
Last updated
07/08/2007
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