Individual
ABIGAIL ANN ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
697 LOUISIANA RD, DYESS AFB, TX 79607-1141
(256) 968-3433
Mailing address
697 LOUISIANA RD, DYESS AFB, TX 79607-1141
(256) 968-3433
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C008611
NC
172V00000X
Community Health Worker
55209
TX
Other
Enumeration date
12/01/2011
Last updated
03/11/2020
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