Provider Demographics
NPI:1154078061
Name:KREITZ, ABIGAIL
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:KREITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 CENTENIAL DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2204
Mailing Address - Country:US
Mailing Address - Phone:772-497-4145
Mailing Address - Fax:
Practice Address - Street 1:2363 S BRANNON STAND RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-7005
Practice Address - Country:US
Practice Address - Phone:334-618-6809
Practice Address - Fax:334-801-0516
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-23-68356103K00000X
FLRBT-20-120198106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst