Provider Demographics
NPI:1265258693
Name:OHARA, ABIGAIL MARIE
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARIE
Last Name:OHARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MCHANEY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2873
Mailing Address - Country:US
Mailing Address - Phone:618-518-9794
Mailing Address - Fax:
Practice Address - Street 1:1705 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-2258
Practice Address - Country:US
Practice Address - Phone:618-382-7311
Practice Address - Fax:618-382-7552
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor