Provider Demographics
NPI:1700560406
Name:LOGAN, JENNIFER D (LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:D
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670121
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-0119
Mailing Address - Country:US
Mailing Address - Phone:770-851-8043
Mailing Address - Fax:
Practice Address - Street 1:6133 LOVE ST
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-4711
Practice Address - Country:US
Practice Address - Phone:678-718-5618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional