Provider Demographics
NPI:1003629304
Name:LOGAN, MICHAEL DEWAYNE (MSW, MCJ, BCJ)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEWAYNE
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MSW, MCJ, BCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-2930
Mailing Address - Country:US
Mailing Address - Phone:864-425-6675
Mailing Address - Fax:
Practice Address - Street 1:201 W MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1773
Practice Address - Country:US
Practice Address - Phone:864-487-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)