Provider Demographics
NPI:1720591597
Name:JOSEPH, ABIGAIL ATHALIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:ATHALIA
Last Name:JOSEPH
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 1:1300 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7214
Mailing Address - Country:US
Mailing Address - Phone:928-226-1056
Mailing Address - Fax:
Practice Address - Street 1:1300 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7214
Practice Address - Country:US
Practice Address - Phone:928-226-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64983104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker