Provider Demographics
NPI:1548067846
Name:DEHART, ABBIGALE CLARE
Entity type:Individual
Prefix:
First Name:ABBIGALE
Middle Name:CLARE
Last Name:DEHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457-7461
Mailing Address - Country:US
Mailing Address - Phone:478-331-8460
Mailing Address - Fax:
Practice Address - Street 1:131 MUSTANG RD
Practice Address - Street 2:
Practice Address - City:SOPERTON
Practice Address - State:GA
Practice Address - Zip Code:30457-7461
Practice Address - Country:US
Practice Address - Phone:478-331-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABACB1182292106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty