Healthcare Provider Details

I. General information

NPI: 1750270997
Provider Name (Legal Business Name): ABUNDANT MENTAL HEALTH SUPPORT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 SUITE 104 KNIGHTDALE BLVD
KNIGHTDALE NC
27545
US

IV. Provider business mailing address

3508 PINKHAM WAY
RALEIGH NC
27616-8322
US

V. Phone/Fax

Practice location:
  • Phone: 952-737-3202
  • Fax: 919-295-1254
Mailing address:
  • Phone: 952-737-3202
  • Fax: 919-295-1254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTHA KERUBO OCHAKO
Title or Position: OWNER/PROVIDER
Credential: NP-BC
Phone: 952-737-3202