Healthcare Provider Details

I. General information

NPI: 1619541331
Provider Name (Legal Business Name): ABIGAIL MOOK MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 WATERS EDGE DR STE 158
RALEIGH NC
27606-2466
US

IV. Provider business mailing address

4904 WATERS EDGE DR STE 158
RALEIGH NC
27606-2466
US

V. Phone/Fax

Practice location:
  • Phone: 919-622-1303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4760
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: