Provider Demographics
NPI:1790059624
Name:BROWN, ABIGAIL MARIE (LPC, CADCII, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC, CADCII, QMHP
Other - Prefix:MS
Other - First Name:ABIGAIL
Other - Middle Name:MARIE
Other - Last Name:GUNNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CADCI, QMHP
Mailing Address - Street 1:1027 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1328
Mailing Address - Country:US
Mailing Address - Phone:503-624-0312
Mailing Address - Fax:503-639-3973
Practice Address - Street 1:18088 SE MARKET ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5055
Practice Address - Country:US
Practice Address - Phone:971-202-7866
Practice Address - Fax:503-492-7379
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3656101YM0800X
OR16-06-18101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health