Healthcare Provider Details

I. General information

NPI: 1073476735
Provider Name (Legal Business Name): ABUNDANCE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9806 STAYMAN CT
DUNKIRK MD
20754-9716
US

IV. Provider business mailing address

9806 STAYMAN CT
DUNKIRK MD
20754-9716
US

V. Phone/Fax

Practice location:
  • Phone: 667-298-5923
  • Fax:
Mailing address:
  • Phone: 667-298-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NAQUITA COLISE GROSS
Title or Position: OWNER/THERAPIST
Credential: LCSW-C
Phone: 667-298-5923