| Doctor Name: | MICHELLE LOGAN |
| NPI Number: | 1730565201 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LLPC |
| License Number: | LC 6024 |
| Business Practice Address: | 1300 York Rd #300 Lutherville Timonium, MD - 210936016 |
| Business Phone Number: | 4108537691 |
| Business Fax Number: | |
| Mailing Address: | 2419 Maryland Ave, BALTIMORE |
| State: | MD |
| Postal Code: | 212185017 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/06/2015 |
| NPI Last Update Date: | 08/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LC 6024 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |