Healthcare Provider Details

I. General information

NPI: 1215764709
Provider Name (Legal Business Name): ABIGAYIL ABRAHAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E TOWN PL STE 110G
ST AUGUSTINE FL
32092-2726
US

IV. Provider business mailing address

101 E TOWN PL STE 110G
ST AUGUSTINE FL
32092-2726
US

V. Phone/Fax

Practice location:
  • Phone: 904-402-7663
  • Fax:
Mailing address:
  • Phone: 904-402-7663
  • 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: ABIGAYIL ABRAHAM
Title or Position: OWNER, LMHC
Credential:
Phone: 904-402-7663