Provider Demographics
NPI:1477747392
Name:HARBOUR-LOGAN, CYNTHIA ANGELA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANGELA
Last Name:HARBOUR-LOGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:ANGELA
Other - Last Name:HARBOUR-LOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8939 S SEPULVEDA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3632
Mailing Address - Country:US
Mailing Address - Phone:310-498-7694
Mailing Address - Fax:
Practice Address - Street 1:38707 JUNIPER TREE RD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4336
Practice Address - Country:US
Practice Address - Phone:310-498-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical