Individual
MS. JACQUELINE LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
108 E PONCE DE LEON AVE STE 204, DECATUR, GA 30030-2512
(404) 382-8788
Mailing address
PO BOX 373119, DECATUR, GA 30037-3119
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC006564
GA
Other
Enumeration date
01/10/2012
Last updated
03/30/2018
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