Provider Demographics
NPI:1437724283
Name:KILLINGER, ABIGAIL ROSE
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ROSE
Last Name:KILLINGER
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 1:15 SEDGEBROOK CT APT 204
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-7265
Mailing Address - Country:US
Mailing Address - Phone:703-819-3566
Mailing Address - Fax:
Practice Address - Street 1:20566 TIMBERLAKE RD STE A
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7221
Practice Address - Country:US
Practice Address - Phone:434-239-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-169276106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician