Individual
MRS. KIM JANISSE LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.,LPC,BCPC
Contact information
Practice address
3011 W. GRAND BLVD., SUITE 423, DETROIT, MI 48202-3011
(313) 664-4900
(313) 664-4901
Mailing address
3011 W. GRAND BLVD., SUITE 423, DETROIT, MI 48202-3011
(313) 664-4900
(313) 664-4901
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
L2437318
MI
101YP2500X
Professional Counselor
Primary
L2437318
MI
Other
Enumeration date
11/09/2007
Last updated
04/14/2015
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