Healthcare Provider Details

I. General information

NPI: 1598551210
Provider Name (Legal Business Name): QUAN ANTHONY ABERNATHY-MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 EXTON CMNS
EXTON PA
19341-2450
US

IV. Provider business mailing address

8 S BACTON HILL RD
MALVERN PA
19355-1503
US

V. Phone/Fax

Practice location:
  • Phone: 610-968-1236
  • Fax:
Mailing address:
  • Phone: 484-318-6803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC001206
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: