Individual
MS. GAYLE VENCE LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA,LMSW,LPC
Contact information
Practice address
2449 GOLF RD STE 14, PHILADELPHIA, PA 19131-1475
(215) 477-3103
(215) 477-3104
Mailing address
2449 GOLF RD STE 14, PHILADELPHIA, PA 19131-1475
(215) 477-3103
(215) 477-3104
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC005429
PA
Other
Enumeration date
08/09/2011
Last updated
08/09/2011
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