Basic Information
Provider Information
NPI: 1952042004
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAMS
FirstName: ABIGAIL
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 107 CRANES ROOST CT
Address2:  
City: ELIZABETHTOWN
State: KY
PostalCode: 427013650
CountryCode: US
TelephoneNumber: 2707652605
FaxNumber:  
Practice Location
Address1: 1072 S DIXIE BLVD
Address2:  
City: RADCLIFF
State: KY
PostalCode: 401601103
CountryCode: US
TelephoneNumber: 2703518166
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/05/2022
LastUpdateDate: 04/05/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/04/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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