Provider Demographics
NPI:1649863812
Name:MABRY, ABBEY (BCBA)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:MABRY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:LAUREN
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:454 REXFORD DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:454 REXFORD DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:SC
Practice Address - Zip Code:29369-9479
Practice Address - Country:US
Practice Address - Phone:864-346-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst