Provider Demographics
NPI:1912207176
Name:LOGAN, DAWN SIMONE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:SIMONE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:SIMONE
Other - Last Name:DURRAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGPC
Mailing Address - Street 1:908 GREENGABLE CT
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-1210
Mailing Address - Country:US
Mailing Address - Phone:202-725-1267
Mailing Address - Fax:
Practice Address - Street 1:908 GREENGABLE CT
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-1210
Practice Address - Country:US
Practice Address - Phone:202-725-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional