Healthcare Provider Details

I. General information

NPI: 1982158788
Provider Name (Legal Business Name): ABBA'S HEART COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 DOUGLAS AVE SUITE 2040
ALTAMONTE SPRINGS FL
32714-2061
US

IV. Provider business mailing address

118 CALICO RD
LAKE MARY FL
32746-3908
US

V. Phone/Fax

Practice location:
  • Phone: 407-285-6284
  • Fax: 407-878-0247
Mailing address:
  • Phone: 407-285-6284
  • Fax: 407-878-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10067
License Number StateFL

VIII. Authorized Official

Name: MRS. ANGIE S MABE
Title or Position: PRESIDENT
Credential: MA, LMHC, NCC, FLQS
Phone: 407-285-6284