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General NPI Number Information
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NPI Number | 1255155289
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Entity Type | Individual
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Provider Name | ABIGAIL BROWN
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Gender | Female
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 16 EMERALD TER
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City | SWANSEA
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State | IL
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Zip | 62226-2321
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Country | US
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Telephone | 618-558-9035
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Fax |
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Provider Business Mailing Address
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Address Line | 4905 MICHAEL DR
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City | GODFREY
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State | IL
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Zip | 62035-1322
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Country | US
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Telephone | 618-419-5110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.020987
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License Number State | IL
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