MEDICARE: ABBA'S HEART COUNSELING CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH10067	FL

General Provider Information

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

Provider Business Mailing Address
First Line	:	118 CALICO RD
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3908
Country	:	US
Telephone Number	:	407-285-6284
Fax Number	:	407-878-0247

Provider Business Practice Location Address
First Line	:	1110 DOUGLAS AVE
Second Line	:	SUITE 2040
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2061
Country	:	US
Telephone Number	:	407-285-6284
Fax Number	:	407-878-0247

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

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/09/2016

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