Provider Demographics
NPI:1699876516
Name:LOGSTON, DONNA JEAN (LPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:LOGSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 S LAKESHORE DR STE 102
Mailing Address - Street 2:14122 W. MCDOWELL RD. #103C, GOODYEAR, AZ 85338
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7047
Mailing Address - Country:US
Mailing Address - Phone:480-755-7875
Mailing Address - Fax:480-775-0660
Practice Address - Street 1:4525 S LAKESHORE DR STE 102
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7047
Practice Address - Country:US
Practice Address - Phone:480-755-7875
Practice Address - Fax:480-775-0660
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health