Provider Demographics
NPI:1497886865
Name:ABERNATHY, NINA S (LPC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:S
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1844
Mailing Address - Country:US
Mailing Address - Phone:636-933-9590
Mailing Address - Fax:636-933-9641
Practice Address - Street 1:410 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1844
Practice Address - Country:US
Practice Address - Phone:636-933-9590
Practice Address - Fax:636-933-9641
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003030515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional