Healthcare Provider Details

I. General information

NPI: 1225779473
Provider Name (Legal Business Name): ABIGAIL MASON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 04/03/2022
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7760 SHRADER RD STE B
HENRICO VA
23228-2552
US

IV. Provider business mailing address

3122 HANES AVE
RICHMOND VA
23222-2623
US

V. Phone/Fax

Practice location:
  • Phone: 804-591-0002
  • Fax:
Mailing address:
  • Phone: 757-618-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010244
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: