Provider Demographics
NPI:1427497544
Name:KERCORIAN, ABIGAIL (LMSW)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:KERCORIAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2735
Mailing Address - Country:US
Mailing Address - Phone:248-336-2868
Mailing Address - Fax:248-336-2879
Practice Address - Street 1:317 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2735
Practice Address - Country:US
Practice Address - Phone:248-336-2868
Practice Address - Fax:248-336-2879
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801071110104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker