Provider Demographics
NPI:1700603099
Name:JUSTICE, TRAVIS LOGAN (BA, CADC)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LOGAN
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:BA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 LIAM PL
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2442
Mailing Address - Country:US
Mailing Address - Phone:443-889-0292
Mailing Address - Fax:
Practice Address - Street 1:1812 NEWPORT GAP PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-6179
Practice Address - Country:US
Practice Address - Phone:302-500-5879
Practice Address - Fax:302-500-5870
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)