Provider Demographics
NPI:1548722408
Name:SANTIAGO, ABBY BROCK (LICSW)
Entity type:Individual
Prefix:MS
First Name:ABBY
Middle Name:BROCK
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:MCGEE
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2650 WOODFERN CT
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-1704
Mailing Address - Country:US
Mailing Address - Phone:205-960-8772
Mailing Address - Fax:
Practice Address - Street 1:3000 RIVERCHASE GALLERIA STE 500
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2365
Practice Address - Country:US
Practice Address - Phone:205-994-8811
Practice Address - Fax:205-994-8812
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4274C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical