Provider Demographics
NPI:1912080359
Name:POWERS, ABIGAIL DORMIRE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:DORMIRE
Last Name:POWERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3606 NEW VISION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1706
Mailing Address - Country:US
Mailing Address - Phone:260-373-1930
Mailing Address - Fax:260-373-1933
Practice Address - Street 1:10311 DAWSONS CREEK BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1913
Practice Address - Country:US
Practice Address - Phone:260-490-5800
Practice Address - Fax:260-490-8722
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040449A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical