Provider Demographics
NPI:1861906240
Name:GREENLEAF, LOGAN PORTER (LCSWA)
Entity type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:PORTER
Last Name:GREENLEAF
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:PORTER
Other - Last Name:GREENLEAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1513 E. FRANKLIN ST.
Mailing Address - Street 2:137D
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514
Mailing Address - Country:US
Mailing Address - Phone:404-451-7938
Mailing Address - Fax:
Practice Address - Street 1:5003 SOUTHPARK DR STE 220
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9414
Practice Address - Country:US
Practice Address - Phone:404-451-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0118601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical