Provider Demographics
NPI:1396555462
Name:ROZEBOOM, ABIGAIL (MS, APC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:ROZEBOOM
Suffix:
Gender:F
Credentials:MS, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13060 LUM CROWE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6388
Mailing Address - Country:US
Mailing Address - Phone:404-683-4091
Mailing Address - Fax:
Practice Address - Street 1:3259 RIVER EXCHANGE ROAD
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092
Practice Address - Country:US
Practice Address - Phone:404-683-4091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health