Provider Demographics
NPI:1356607386
Name:LOGGINS, KIA NICOLE (MA)
Entity type:Individual
Prefix:MRS
First Name:KIA
Middle Name:NICOLE
Last Name:LOGGINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 BLUE RAVEN CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7401
Mailing Address - Country:US
Mailing Address - Phone:407-900-9579
Mailing Address - Fax:
Practice Address - Street 1:517 DELTONA BLVD STE B
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8016
Practice Address - Country:US
Practice Address - Phone:386-473-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor