Provider Demographics
NPI:1588375778
Name:LOGAN, DANA ADAMS (DSW, LICSW)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:ADAMS
Last Name:LOGAN
Suffix:
Gender:F
Credentials:DSW, LICSW
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1146 COUNTY ROAD 297
Mailing Address - Street 2:
Mailing Address - City:SARGENT
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3652
Mailing Address - Country:US
Mailing Address - Phone:504-274-8654
Mailing Address - Fax:
Practice Address - Street 1:1146 COUNTY ROAD 297
Practice Address - Street 2:
Practice Address - City:SARGENT
Practice Address - State:TX
Practice Address - Zip Code:77414-3652
Practice Address - Country:US
Practice Address - Phone:504-274-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3940C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical