Provider Demographics
NPI:1093114357
Name:LONG, ABIGAIL (LMFT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9820 WILLOW CREEK RD STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1114
Mailing Address - Country:US
Mailing Address - Phone:619-549-0329
Mailing Address - Fax:619-550-3547
Practice Address - Street 1:9820 WILLOW CREEK RD STE 240
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1114
Practice Address - Country:US
Practice Address - Phone:619-549-0329
Practice Address - Fax:619-550-3547
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT107618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist