Active NPI
Logan Rene Nickerson, CADC
- Addiction (Substance Use Disorder) Counselor
- Dover, DE
National Provider Identifier
1487465704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 2346
- Practice address
- 103 Wolf Creek Blvd Ste 2&3
Dover, DE 19901-4967 - Phone
- (302) 744-8474
- NPI assigned
- Jan 16, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 2346 | DE | Primary |
Addresses
Primary practice location
103 Wolf Creek Blvd Ste 2&3
Dover, DE 19901-4967
Mailing address
114 Logan Dr
Dover, DE 19901-1583
Phone (302) 505-0384
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2346 | DE | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736985600000",
"number": "1487465704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 LOGAN DR",
"city": "DOVER",
"state": "DE",
"postal_code": "199011583",
"telephone_number": "302-505-0384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 WOLF CREEK BLVD STE 2&3",
"city": "DOVER",
"state": "DE",
"postal_code": "199014967",
"telephone_number": "302-744-8474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "LOGAN",
"middle_name": "RENE",
"credential": "CADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-01-16",
"last_updated": "2025-01-16",
"certification_date": "2025-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "DE",
"license": "2346",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dover, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.