Provider Demographics
NPI:1619200284
Name:BOERNER, ABBY C (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:C
Last Name:BOERNER
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 1:605 DEPOT DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-6709
Mailing Address - Country:US
Mailing Address - Phone:912-690-0324
Mailing Address - Fax:912-858-4350
Practice Address - Street 1:112 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5309
Practice Address - Country:US
Practice Address - Phone:912-690-0324
Practice Address - Fax:912-858-4350
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional