Organization
ABUNDANT LIFE COMMUNITY DEVELOPMENT CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLIS FAGBAMI (PRESIDENT)
(302) 983-6436
Entity
Organization
Contact information
Practice address
24 BLEVINS DR, NEW CASTLE, DE 19720-4152
(302) 983-6436
Mailing address
24 BLEVINS DR, NEW CASTLE, DE 19720-4152
(302) 983-6436
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
103TR0400X
Rehabilitation Psychologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Enumeration date
06/01/2016
Last updated
12/09/2016
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