Organization
ABIDE HEALTHCARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
QUEEN AMEZE OMOKARO-AGBONIFO (CEO)
(972) 375-3354
Entity
Organization
Contact information
Practice address
6951 SEABREEZE DR, GRAND PRAIRIE, TX 75054-7282
(972) 375-3354
Mailing address
6951 SEABREEZE DR, GRAND PRAIRIE, TX 75054-7282
(972) 375-3354
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JEA003458160
BLUECROSS BLUESHIELD
TX
Enumeration date
09/15/2018
Last updated
09/15/2018
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