Provider Demographics
NPI:1639918360
Name:TOMPKINS, LOGAN PAIGE (RBT)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:PAIGE
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 LAUREL GLEN CIR APT 23
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-3690
Mailing Address - Country:US
Mailing Address - Phone:276-759-4634
Mailing Address - Fax:
Practice Address - Street 1:1708 AUGUSTA ST STE C226
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-6513
Practice Address - Country:US
Practice Address - Phone:185-583-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician