Provider Demographics
NPI:1215497219
Name:ABUNDANT LIFE COUNSELING
Entity type:Organization
Organization Name:ABUNDANT LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:973-865-5972
Mailing Address - Street 1:6 DONNA LYNN LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2822
Mailing Address - Country:US
Mailing Address - Phone:973-865-5972
Mailing Address - Fax:
Practice Address - Street 1:33 S DELAWARE AVE STE 101B
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1524
Practice Address - Country:US
Practice Address - Phone:973-865-5972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ14145671OtherCAQH