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General NPI Number Information
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NPI Number | 1548953201
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Entity Type | Individual
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Provider Name | ALEXIS LOGAN
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Gender | Female
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 8133 LEESBURG PIKE STE 130
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City | VIENNA
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State | VA
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Zip | 22182-2706
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Country | US
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Telephone | 703-682-0163
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Fax |
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Provider Business Mailing Address
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Address Line | 7709 MARTEL PL
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1946
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Country | US
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Telephone | 703-944-4046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904019709
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License Number State | VA
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