Individual
JEORGE L LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDCIIII
Contact information
Practice address
601 S EDWIN C MOSES BLVD, DAYTON, OH 45417-3424
(937) 734-8333
Mailing address
601 S EDWIN C MOSES BLVD, DAYTON, OH 45417-3424
(937) 734-8333
(937) 734-4343
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDC.151219-3
OH
Other
Enumeration date
07/11/2016
Last updated
07/11/2016
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