Healthcare Provider Details

I. General information

NPI: 1518794478
Provider Name (Legal Business Name): ABIGAIL COUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 DEERHORN LN
FELTON CA
95018-9421
US

IV. Provider business mailing address

3531 REDWOOD DR
APTOS CA
95003-2503
US

V. Phone/Fax

Practice location:
  • Phone: 407-739-8974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: