Provider Demographics
NPI:1528280856
Name:ABBOTT, DAVID D (MS PCC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MS PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9945 PASCO MONTRA RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-3564
Mailing Address - Country:US
Mailing Address - Phone:800-532-7239
Mailing Address - Fax:
Practice Address - Street 1:10100 ELIDA RD
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9056
Practice Address - Country:US
Practice Address - Phone:419-695-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 3619101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor