Healthcare Provider Details

I. General information

NPI: 1134023252
Provider Name (Legal Business Name): LOGAN CLINE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 GUN CLUB RD
WEST PALM BEACH FL
33406-3093
US

IV. Provider business mailing address

177 MULLIGAN DR
COHUTTA GA
30710-0010
US

V. Phone/Fax

Practice location:
  • Phone: 561-688-4358
  • Fax:
Mailing address:
  • Phone: 470-896-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW27193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: