Healthcare Provider Details

I. General information

NPI: 1447918909
Provider Name (Legal Business Name): ABIGAIL LEE LONGACRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31557 SCHOOLCRAFT RD STE 200
LIVONIA MI
48150-1848
US

IV. Provider business mailing address

575 S MAIN ST
PLYMOUTH MI
48170-1778
US

V. Phone/Fax

Practice location:
  • Phone: 844-244-1818
  • Fax:
Mailing address:
  • Phone: 734-451-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: