Healthcare Provider Details

I. General information

NPI: 1306771621
Provider Name (Legal Business Name): ABIGAIL WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 07/21/2026
Certification Date: 06/17/2026
Deactivation Date: 06/22/2026
Reactivation Date: 07/21/2026

III. Provider practice location address

410 N PRINCE ST
LANCASTER PA
17603-3010
US

IV. Provider business mailing address

1809 HEMLOCK RD
LANCASTER PA
17603-4437
US

V. Phone/Fax

Practice location:
  • Phone: 717-560-7917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: