Healthcare Provider Details

I. General information

NPI: 1932725132
Provider Name (Legal Business Name): ABIGAIL JOY HARBOR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4572 S HAGADORN RD
EAST LANSING MI
48823-5385
US

IV. Provider business mailing address

109 WILKINSON ST
CHELSEA MI
48118-1322
US

V. Phone/Fax

Practice location:
  • Phone: 517-481-2133
  • Fax:
Mailing address:
  • Phone: 248-891-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: