Provider Demographics
NPI:1073137675
Name:HAFEZ, LOGAINA (MA, GCDF)
Entity Type:Individual
Prefix:
First Name:LOGAINA
Middle Name:
Last Name:HAFEZ
Suffix:
Gender:F
Credentials:MA, GCDF
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:HAFEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, GCDF
Mailing Address - Street 1:46600 ELLICOTT SQ UNIT 101
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-4323
Mailing Address - Country:US
Mailing Address - Phone:703-463-0392
Mailing Address - Fax:
Practice Address - Street 1:1485 CHAIN BRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4501
Practice Address - Country:US
Practice Address - Phone:703-534-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health