Healthcare Provider Details

I. General information

NPI: 1750252482
Provider Name (Legal Business Name): LOGAN KATHERINE SHELMADINE MFT-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 NORTHWEST LN
WARRENSVILLE NC
28693-9244
US

IV. Provider business mailing address

PO BOX 208
JEFFERSON NC
28640-0208
US

V. Phone/Fax

Practice location:
  • Phone: 828-303-2938
  • Fax:
Mailing address:
  • Phone: 336-246-9449
  • Fax: 336-982-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number20837A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: