Provider Demographics
NPI:1851639777
Name:LOGAN, MARION WILSON
Entity Type:Individual
Prefix:MR
First Name:MARION
Middle Name:WILSON
Last Name:LOGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PIIKOI ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3139
Mailing Address - Country:US
Mailing Address - Phone:808-596-8433
Mailing Address - Fax:
Practice Address - Street 1:615 PIIKOI ST STE 105
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3139
Practice Address - Country:US
Practice Address - Phone:808-596-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)