Healthcare Provider Details

I. General information

NPI: 1104243641
Provider Name (Legal Business Name): ABBY KIDD MA, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2014
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 HERITAGE ST
BLACKLICK OH
43004-6063
US

IV. Provider business mailing address

941 CHATHAM LN SUITE 103
COLUMBUS OH
43221-2416
US

V. Phone/Fax

Practice location:
  • Phone: 614-205-3068
  • Fax:
Mailing address:
  • Phone: 614-568-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.10000327-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC. 1000571
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: