Healthcare Provider Details

I. General information

NPI: 1245183185
Provider Name (Legal Business Name): ABIGAIL COPPOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N DREXEL AVE
INDIANAPOLIS IN
46201-3735
US

IV. Provider business mailing address

31 N DREXEL AVE
INDIANAPOLIS IN
46201-3735
US

V. Phone/Fax

Practice location:
  • Phone: 317-749-3773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: