Provider Demographics
NPI:1235966532
Name:YORK, MARY ABIGAIL (MS, P-LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ABIGAIL
Last Name:YORK
Suffix:
Gender:F
Credentials:MS, P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COLLEGE HILL RD APT 2201
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-2766
Mailing Address - Country:US
Mailing Address - Phone:601-818-5307
Mailing Address - Fax:
Practice Address - Street 1:304 ENTERPRISE DR STE C2201
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2762
Practice Address - Country:US
Practice Address - Phone:662-638-3538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health