Provider Demographics
NPI:1922323088
Name:ABUNDANT LIFE COUNSELING CENTER, INCORPORATED
Entity Type:Organization
Organization Name:ABUNDANT LIFE COUNSELING CENTER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARTREINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-913-5231
Mailing Address - Street 1:459 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4752
Mailing Address - Country:US
Mailing Address - Phone:617-354-2522
Mailing Address - Fax:
Practice Address - Street 1:459 PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4752
Practice Address - Country:US
Practice Address - Phone:617-354-2522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health