Provider Demographics
NPI:1619584307
Name:HOPE ABUNDANCE BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:HOPE ABUNDANCE BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMANI
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:WILLIAMS-EPHRIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW QS
Authorized Official - Phone:954-560-4279
Mailing Address - Street 1:1314 E LAS OLAS BLVD STE 1590
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2334
Mailing Address - Country:US
Mailing Address - Phone:954-560-4279
Mailing Address - Fax:
Practice Address - Street 1:1816 E OAKLAND PARK BLVD APT 61
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1118
Practice Address - Country:US
Practice Address - Phone:954-560-4279
Practice Address - Fax:954-522-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619584307OtherNPI
1669927653OtherNPI