Healthcare Provider Details

I. General information

NPI: 1093620783
Provider Name (Legal Business Name): ABIGAIL SOUTHERS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5036 DORSEY HALL DR STE 205
ELLICOTT CITY MD
21042-7935
US

IV. Provider business mailing address

5036 DORSEY HALL DR STE 205
ELLICOTT CITY MD
21042-7935
US

V. Phone/Fax

Practice location:
  • Phone: 410-884-9200
  • Fax: 410-904-6740
Mailing address:
  • Phone: 410-884-9200
  • Fax: 410-904-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32229
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: