Provider Demographics
NPI:1801505045
Name:MINNICH, ABIGAIL CATHERINE
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:CATHERINE
Last Name:MINNICH
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 1:550 KUNEHI ST APT 206
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2069
Mailing Address - Country:US
Mailing Address - Phone:808-674-6641
Mailing Address - Fax:
Practice Address - Street 1:4788 E ELUA WAY APT D
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3008
Practice Address - Country:US
Practice Address - Phone:808-674-6641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-22-244446106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician