Provider Demographics
NPI:1003825688
Name:L'ABBE, JANET ELLEN (PH D)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ELLEN
Last Name:L'ABBE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 GARDNERS LN
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-4740
Mailing Address - Country:US
Mailing Address - Phone:757-469-8989
Mailing Address - Fax:
Practice Address - Street 1:1321 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6000
Practice Address - Country:US
Practice Address - Phone:757-469-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR011P103TC0700X
VA0180004170103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154450744Medicaid
AR5W268Medicare ID - Type UnspecifiedDOMHA AR