Provider Demographics
NPI:1093887556
Name:LEONE, ABIGAIL DEWITT (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:DEWITT
Last Name:LEONE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 NEW COVENANT RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31001
Mailing Address - Country:US
Mailing Address - Phone:843-425-3454
Mailing Address - Fax:843-300-1063
Practice Address - Street 1:246 NEW COVENANT RD.
Practice Address - Street 2:SUITE 5
Practice Address - City:ABBEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31001
Practice Address - Country:US
Practice Address - Phone:843-425-3454
Practice Address - Fax:843-300-1063
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4772174400000X, 101YP2500X
GALPC008167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003155023AMedicaid
SCPC1065Medicaid
SC17OtherOTHER SERVICES