Provider Demographics
NPI:1821715467
Name:ABHAYA PLLC
Entity Type:Organization
Organization Name:ABHAYA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC/LCAS
Authorized Official - Phone:646-872-7527
Mailing Address - Street 1:3710 UNIVERSITY DR STE 120
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6204
Mailing Address - Country:US
Mailing Address - Phone:919-906-4390
Mailing Address - Fax:
Practice Address - Street 1:3710 UNIVERSITY DR STE 120
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6204
Practice Address - Country:US
Practice Address - Phone:919-906-4390
Practice Address - Fax:828-544-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health