Healthcare Provider Details

I. General information

NPI: 1629688205
Provider Name (Legal Business Name): ABDO COUNSELING AND CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 SAM NEWELL RD STE D2
MATTHEWS NC
28105-5162
US

IV. Provider business mailing address

1118 SAM NEWELL RD STE D2
MATTHEWS NC
28105-5162
US

V. Phone/Fax

Practice location:
  • Phone: 980-224-6612
  • Fax:
Mailing address:
  • Phone: 980-224-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOANN M ABDO
Title or Position: LEAD THERAPIST
Credential: LCSW
Phone: 980-224-6612