Provider Demographics
NPI:1144609124
Name:LAWRENCE, ABIGAIL CHRISTINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:CHRISTINE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:DOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12901 CENTRE PARK CIR APT 115
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5810
Mailing Address - Country:US
Mailing Address - Phone:304-767-1711
Mailing Address - Fax:
Practice Address - Street 1:9642 BURKE LAKE RD STE 1
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3024
Practice Address - Country:US
Practice Address - Phone:703-425-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09267235Z00000X
TN6656235Z00000X
WVSLP-1697235Z00000X
VA2202009508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist