Healthcare Provider Details

I. General information

NPI: 1841082682
Provider Name (Legal Business Name): ABIGAIL LANFORD M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 202A
ST AUGUSTINE FL
32080-3111
US

IV. Provider business mailing address

116C RIO DEL MAR ST
ST AUGUSTINE FL
32080-6462
US

V. Phone/Fax

Practice location:
  • Phone: 306-287-1905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH24626
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: