Provider Demographics
NPI:1003670985
Name:SHOUN, ABIGAIL (BCABA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:SHOUN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3700
Mailing Address - Country:US
Mailing Address - Phone:804-897-1753
Mailing Address - Fax:
Practice Address - Street 1:911 STURBRIDGE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3700
Practice Address - Country:US
Practice Address - Phone:804-897-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000543106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst