Healthcare Provider Details

I. General information

NPI: 1467270553
Provider Name (Legal Business Name): ABIGAIL ADANNEYA DYBOH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CULLEN BLVD
PEARLAND TX
77584-3921
US

IV. Provider business mailing address

707 BOER PLAINS DR
ROSHARON TX
77583-4905
US

V. Phone/Fax

Practice location:
  • Phone: 832-905-9211
  • Fax:
Mailing address:
  • Phone: 281-608-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number89658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: