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General NPI Number Information
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NPI Number | 1205596715
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE LLC
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Dates
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Enumeration Date | 12/23/2021
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 10026 E 21ST STREET STE 15
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-1802
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Country | US
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Telephone | 317-943-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 10026 E 21ST STREET STE 15
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-1802
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Country | US
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Telephone | 317-943-1101
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRIMSETTA LAJEANNA DUNN
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Credential | LCSW
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Telephone | 317-493-9309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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