Individual
NICOLE R LOGIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
(616) 456-7775
(616) 774-2044
Mailing address
1101 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1061979429
—
MI
Enumeration date
09/29/2017
Last updated
09/29/2017
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