Provider Demographics
NPI:1104243641
Name:KIDD, ABBY (MA, LPCC-S)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:KIDD
Suffix:
Gender:F
Credentials:MA, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 CHATHAM LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2416
Mailing Address - Country:US
Mailing Address - Phone:614-568-3317
Mailing Address - Fax:
Practice Address - Street 1:1047 HERITAGE ST
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-6063
Practice Address - Country:US
Practice Address - Phone:614-205-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC. 1000571101YP2500X
OHE.10000327-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional