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General NPI Number Information
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NPI Number | 1972088045
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE AND WELLNESS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 1812 ENCORE TER
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City | SEVERN
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State | MD
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Zip | 21144
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Country | US
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Telephone | 240-856-4526
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Fax |
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Provider Business Mailing Address
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Address Line | 2657-G ANNAPOLIS ROAD #297
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City | HANOVER
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State | MD
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Zip | 21076
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Country | US
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Telephone | 240-856-4526
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/MENTAL HEALTH CLINICIAN
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Name | MRS. KAMICA MELISSA SPEAKS
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Credential | LCPC
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Telephone | 504-453-8444
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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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