Healthcare Provider Details

I. General information

NPI: 1093515892
Provider Name (Legal Business Name): ABBIE ELIZABETH ALLEN BA, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26105 ORCHARD LAKE RD STE 207
FARMINGTON HILLS MI
48334-4578
US

IV. Provider business mailing address

29661 CITATION CIR APT 12208
FARMINGTON HILLS MI
48331-5828
US

V. Phone/Fax

Practice location:
  • Phone: 248-662-5437
  • Fax:
Mailing address:
  • Phone: 313-605-0098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6352001146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: