Healthcare Provider Details

I. General information

NPI: 1356826143
Provider Name (Legal Business Name): ABIGAIL IDA DURHAM MSW, LSSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TIMBER CREEK DR STE 2
CORDOVA TN
38018-4236
US

IV. Provider business mailing address

5176 WARFIELD DR
MEMPHIS TN
38117-2130
US

V. Phone/Fax

Practice location:
  • Phone: 901-248-0595
  • Fax: 888-977-2994
Mailing address:
  • Phone: 901-570-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateTN

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: