Provider Demographics
NPI:1356826143
Name:DURHAM, ABIGAIL IDA (MSW, LSSW)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:IDA
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MSW, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5176 WARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-2130
Mailing Address - Country:US
Mailing Address - Phone:901-570-2655
Mailing Address - Fax:
Practice Address - Street 1:150 TIMBER CREEK DR STE 2
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4236
Practice Address - Country:US
Practice Address - Phone:901-248-0595
Practice Address - Fax:888-977-2994
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool