Provider Demographics
NPI:1164121000
Name:ISACSON, ABIGAIL LEA (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:LEA
Last Name:ISACSON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:ISACSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11003 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1053
Mailing Address - Country:US
Mailing Address - Phone:419-913-8553
Mailing Address - Fax:
Practice Address - Street 1:2387 S LINDEN RD STE 120
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5487
Practice Address - Country:US
Practice Address - Phone:810-701-8493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851115844101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health