Provider Demographics
NPI:1265156244
Name:ANTHOLD, ABIGAYLE AMANDA (MA, MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:ABIGAYLE
Middle Name:AMANDA
Last Name:ANTHOLD
Suffix:
Gender:F
Credentials:MA, MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FOXCROFT AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-5341
Mailing Address - Country:US
Mailing Address - Phone:717-880-2052
Mailing Address - Fax:
Practice Address - Street 1:300 FOXCROFT AVE STE 307
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-5341
Practice Address - Country:US
Practice Address - Phone:717-880-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009439191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical