MEDICARE: MS. MARY THERESA ABRAHAM MS LPC NCC MAC CPCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	003709	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10063297	OTHER	GA	AMERIGROUP
2	5732533	OTHER	GA	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	726881000	OTHER	GA	MAGELLAN
5	582262349	OTHER	GA	HUMANA
6	10063295	OTHER	GA	AMERIGROUP
7	1427124593	OTHER	GA	BCBS

General Provider Information

NPI Number	:	1427124593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY THERESA ABRAHAM MS LPC NCC MAC CPCS

Provider Business Mailing Address
First Line	:	707 WHITLOCK AVE SW
Second Line	:	SUITE H-10
City	:	MARIETTA
State	:	GA
Zip	:	30064-3000
Country	:	US
Telephone Number	:	770-591-7518
Fax Number	:	678-498-2843

Provider Business Practice Location Address
First Line	:	707 WHITLOCK AVE SW
Second Line	:	SUITE H-10
City	:	MARIETTA
State	:	GA
Zip	:	30064-3000
Country	:	US
Telephone Number	:	770-591-7518
Fax Number	:	678-498-2843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	04/09/2024

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