Provider Demographics
NPI:1538536149
Name:LOGAN, TONYA M (LICSW, LCSW-C)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:M
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:MS
Other - First Name:TONYA M
Other - Middle Name:
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW, LCSW-C
Mailing Address - Street 1:1662 VILLAGE GRN STE 100
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2014
Mailing Address - Country:US
Mailing Address - Phone:301-518-6215
Mailing Address - Fax:
Practice Address - Street 1:1662 VILLAGE GRN STE 100
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2014
Practice Address - Country:US
Practice Address - Phone:301-518-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3023381041C0700X
MD079321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical