Healthcare Provider Details

I. General information

NPI: 1073110094
Provider Name (Legal Business Name): ABIGAIL ELIZABETH ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 BENTON DR # C
REDDING CA
96003-5349
US

IV. Provider business mailing address

2280 BENTON DR # C
REDDING CA
96003-5349
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-2020
  • Fax:
Mailing address:
  • Phone: 720-684-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: