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General NPI Number Information
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NPI Number | 1790301604
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Entity Type | Individual
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Provider Name | LEAH L LOGAN LCMHC-A
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Gender | Female
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 04/12/2026
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Provider Practice Location Address
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Address Line | 635 COX RD STE B
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City | GASTONIA
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State | NC
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Zip | 28054-3441
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Country | US
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Telephone | 704-691-7561
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Fax | 704-691-7563
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Provider Business Mailing Address
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Address Line | 119 SANTE CIR
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City | GASTONIA
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State | NC
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Zip | 28052-9215
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Country | US
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Telephone | 704-534-3560
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A15587
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License Number State | NC
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