Provider Demographics
NPI:1568658516
Name:ABUNDANT HEALTH AND HUMAN SERVICES
Entity Type:Organization
Organization Name:ABUNDANT HEALTH AND HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELORS/QUALIFIED
Authorized Official - Phone:252-335-9400
Mailing Address - Street 1:P.O. BOX 2751
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27906-2751
Mailing Address - Country:US
Mailing Address - Phone:252-335-9400
Mailing Address - Fax:252-335-9404
Practice Address - Street 1:401 S GRIFFIN ST
Practice Address - Street 2:SUITE 175
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-335-9400
Practice Address - Fax:252-335-9404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABUNDANT HEALTH AND HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-23
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 251S00000X, 261QM0850X, 261QM0855X
NC2000015102084P0800X
NC251B00000X
NCMHL-070-051251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty