Provider Demographics
NPI:1447721428
Name:SQUIRES, ABIGAIL NICOLE (LPCA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:NICOLE
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5450
Mailing Address - Country:US
Mailing Address - Phone:980-484-2111
Mailing Address - Fax:704-259-0480
Practice Address - Street 1:331 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5450
Practice Address - Country:US
Practice Address - Phone:980-484-2111
Practice Address - Fax:704-259-0480
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional