Provider Demographics
NPI:1780321448
Name:GRUBBS, ABIGAIL (LCSW)
Entity type:Individual
Prefix:MISS
First Name:ABIGAIL
Middle Name:
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:GRUBBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:897 E MADDOX RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-7424
Mailing Address - Country:US
Mailing Address - Phone:678-588-2016
Mailing Address - Fax:
Practice Address - Street 1:1690 STONE VILLAGE LN NW STE 622
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7777
Practice Address - Country:US
Practice Address - Phone:678-588-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-15
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW009102104100000X
GACSW0086011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker