=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477267920
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABIGAIL ERDMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2023
-----------------------------------------------------
Last Update Date | 09/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3522 WEBSTER RD
-----------------------------------------------------
City | BLUE RIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24064-1980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-977-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5733 SIERRA DR
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24012-1111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-871-8448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0704016184
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------