Provider Demographics
NPI:1598160392
Name:LEARNING ON THE LOG
Entity Type:Organization
Organization Name:LEARNING ON THE LOG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FENGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAPC
Authorized Official - Phone:404-579-3048
Mailing Address - Street 1:9 DUNWOODY PARK
Mailing Address - Street 2:SUITE 133
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:678-561-7589
Mailing Address - Fax:801-460-9414
Practice Address - Street 1:230 HAMMOND DR
Practice Address - Street 2:SUITE 330
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:678-561-7589
Practice Address - Fax:801-460-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty