Provider Demographics
NPI:1295035475
Name:ABUNDANT HEALTH FOR RELATIONSHIPS
Entity Type:Organization
Organization Name:ABUNDANT HEALTH FOR RELATIONSHIPS
Other - Org Name:ABUNDANT HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:HOLLAND
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-234-0843
Mailing Address - Street 1:319 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3613
Mailing Address - Country:US
Mailing Address - Phone:856-234-0843
Mailing Address - Fax:856-234-0843
Practice Address - Street 1:319 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3613
Practice Address - Country:US
Practice Address - Phone:856-234-0843
Practice Address - Fax:856-234-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046067001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ598155000OtherMAGELLAN BEHAVIORAL HEALTH
NJ166802OtherMEDICARE PTAN #