Healthcare Provider Details

I. General information

NPI: 1487023040
Provider Name (Legal Business Name): DANIELLE ABRAHAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N BALLARD RD STE C
APPLETON WI
54911-9002
US

IV. Provider business mailing address

3301 N BALLARD RD STE C
APPLETON WI
54911-9002
US

V. Phone/Fax

Practice location:
  • Phone: 920-941-8326
  • Fax:
Mailing address:
  • Phone: 920-941-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6064-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: