Provider Demographics
NPI:1689249823
Name:ABUNDANT LIFE MENTAL HEALTH & WELLNESS
Entity Type:Organization
Organization Name:ABUNDANT LIFE MENTAL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NP
Authorized Official - Prefix:
Authorized Official - First Name:LORRI
Authorized Official - Middle Name:T
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:443-494-8114
Mailing Address - Street 1:133 N WEST ST STE G
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2709
Mailing Address - Country:US
Mailing Address - Phone:443-494-8114
Mailing Address - Fax:
Practice Address - Street 1:133 N WEST ST STE G
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2709
Practice Address - Country:US
Practice Address - Phone:443-494-8114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)