Provider Demographics
NPI:1336326842
Name:LOGAN, MEGAN D (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:D
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:D
Other - Last Name:HASZARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:157 HAMPTON POINT DR
Mailing Address - Street 2:STE 1
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3054
Mailing Address - Country:US
Mailing Address - Phone:904-553-8398
Mailing Address - Fax:904-448-0349
Practice Address - Street 1:157 HAMPTON POINT DR
Practice Address - Street 2:STE 1
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3054
Practice Address - Country:US
Practice Address - Phone:904-553-8398
Practice Address - Fax:904-448-0349
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW83471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical