Provider Demographics
NPI:1881374783
Name:ABUNDANT LIFE MENTAL HEALTH LLC
Entity type:Organization
Organization Name:ABUNDANT LIFE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRIEKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-446-1220
Mailing Address - Street 1:101 SANTANDER DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-2004
Mailing Address - Country:US
Mailing Address - Phone:337-446-1220
Mailing Address - Fax:
Practice Address - Street 1:101 SANTANDER DR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-2004
Practice Address - Country:US
Practice Address - Phone:337-446-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health