Provider Demographics
NPI:1912231739
Name:ROBERTS, LOGAN PAIGE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOGAN
Middle Name:PAIGE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:LOGAN
Other - Middle Name:PAIGE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6151 ALPHA RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-3532
Mailing Address - Country:US
Mailing Address - Phone:214-629-6610
Mailing Address - Fax:
Practice Address - Street 1:14130 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8623
Practice Address - Country:US
Practice Address - Phone:972-980-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical