Provider Demographics
NPI:1437520814
Name:SMITH, ABIGAIL (LCSW)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2880
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0375
Mailing Address - Country:US
Mailing Address - Phone:541-505-5556
Mailing Address - Fax:541-683-6175
Practice Address - Street 1:541 WILLAMETTE ST
Practice Address - Street 2:SUITE 306
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2612
Practice Address - Country:US
Practice Address - Phone:541-505-5556
Practice Address - Fax:541-683-6175
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical