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Organization
LIFE OF ABUNDANCE BEHAVIORAL HEALTH SERVICES LLC
Active
Organization
LIFE OF ABUNDANCE BEHAVIORAL HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE EJIM LCPC (CEO/DIRECTOR)
(443) 721-7574
Entity
Organization
Contact information
Practice address
7544 HOLABIRD AVE, DUNDALK, MD 21222-2104
(443) 721-7574
Mailing address
1281 SUGARWOOD CIR, ESSEX, MD 21221-5447
(443) 721-7574
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
225C00000X
Rehabilitation Counselor
—
NULL
225C00000X
Rehabilitation Counselor
—
—
Other
Enumeration date
11/04/2019
Last updated
05/27/2021
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