Provider Demographics
NPI:1619273711
Name:MITCHELL'LOCKWOOD, ABIGAIL L (LPCC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:L
Last Name:MITCHELL'LOCKWOOD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:L
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1200 N WHITE SANDS BLVD
Mailing Address - Street 2:# 111
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6774
Mailing Address - Country:US
Mailing Address - Phone:575-443-6166
Mailing Address - Fax:575-437-0755
Practice Address - Street 1:340 CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-7834
Practice Address - Country:US
Practice Address - Phone:575-443-6166
Practice Address - Fax:575-437-0755
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0149931101YM0800X
IL180.007702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional