Provider Demographics
NPI:1972088045
Name:ABUNDANT LIFE AND WELLNESS COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ABUNDANT LIFE AND WELLNESS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMICA
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:SPEAKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:504-453-8444
Mailing Address - Street 1:2657-G ANNAPOLIS ROAD
Mailing Address - Street 2:#297
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076
Mailing Address - Country:US
Mailing Address - Phone:240-856-4526
Mailing Address - Fax:
Practice Address - Street 1:1812 ENCORE TER
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144
Practice Address - Country:US
Practice Address - Phone:240-856-4526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty