Provider Demographics
NPI:1346507332
Name:ABBA ENTERPRISES LLC
Entity Type:Organization
Organization Name:ABBA ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-752-7881
Mailing Address - Street 1:2301 RESEARCH BLVD
Mailing Address - Street 2:302
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3204
Mailing Address - Country:US
Mailing Address - Phone:703-752-7881
Mailing Address - Fax:703-752-7880
Practice Address - Street 1:2301 RESEARCH BLVD
Practice Address - Street 2:302
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6265
Practice Address - Country:US
Practice Address - Phone:703-752-7881
Practice Address - Fax:703-752-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty