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General NPI Number Information
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NPI Number | 1841341682
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Entity Type | Individual
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Provider Name | AMEL LOGAN LPC
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 6120 BRANDON AVE STE 117
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2504
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Country | US
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Telephone | 703-887-9582
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Fax | 703-455-1502
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Provider Business Mailing Address
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Address Line | PO BOX 1610
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City | NEWINGTON
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State | VA
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Zip | 22122-1610
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Country | US
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Telephone | 703-887-9582
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Fax | 703-455-1502
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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 | 0701004104
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License Number State | VA
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