Healthcare Provider Details

I. General information

NPI: 1104628213
Provider Name (Legal Business Name): ABIGAIL MARIE FARRIS LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 COLLINS FERRY RD
MORGANTOWN WV
26505-2378
US

IV. Provider business mailing address

3923 BEAR MOUNTAIN RD
BRIDGEPORT WV
26330-8008
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4214
  • Fax: 304-598-6383
Mailing address:
  • Phone: 304-931-6176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBP00947152
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: