Provider Demographics
NPI:1427124593
Name:ABRAHAM, MARY THERESA (MS LPC NCC MAC CPCS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:THERESA
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MS LPC NCC MAC CPCS
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 WHITLOCK AVE SW
Mailing Address - Street 2:SUITE H-10
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3000
Mailing Address - Country:US
Mailing Address - Phone:770-591-7518
Mailing Address - Fax:678-498-2843
Practice Address - Street 1:707 WHITLOCK AVE SW
Practice Address - Street 2:SUITE H-10
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3000
Practice Address - Country:US
Practice Address - Phone:770-591-7518
Practice Address - Fax:678-498-2843
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10063297OtherAMERIGROUP
GA5732533OtherAETNA
GA129577652AMedicaid
GA726881000OtherMAGELLAN
GA582262349OtherHUMANA
GA10063295OtherAMERIGROUP
GA1427124593OtherBCBS