Provider Demographics
NPI:1104419167
Name:ABAGA, CARLY (LPCC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:ABAGA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N 3RD ST STE 230
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3874
Mailing Address - Country:US
Mailing Address - Phone:701-299-9420
Mailing Address - Fax:
Practice Address - Street 1:120 N 3RD ST STE 230
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3874
Practice Address - Country:US
Practice Address - Phone:701-299-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional