Provider Demographics
NPI:1073179438
Name:LOGUE, ALLISON (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:LOGUE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4384
Mailing Address - Country:US
Mailing Address - Phone:858-204-3204
Mailing Address - Fax:
Practice Address - Street 1:6183 PASEO DEL NORTE STE 110
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1151
Practice Address - Country:US
Practice Address - Phone:858-208-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-11
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112033101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health