Provider Demographics
NPI:1093434003
Name:SMITH, ABIGAIL (MS, LPC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:ABI
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:578 N KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6883
Mailing Address - Country:US
Mailing Address - Phone:972-638-0119
Mailing Address - Fax:
Practice Address - Street 1:578 N KIMBALL AVE STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6897
Practice Address - Country:US
Practice Address - Phone:972-638-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional