NPIMap

Organization Active NPI

Life of Abundance Behavioral Health Services LLC

  • Mental Health Counselor
  • Dundalk, MD
National Provider Identifier
1235773193
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
LIFE OF ABUNDANCE BEHAVIORAL HEALTH SERVICES LLC
Practice address
7544 Holabird Ave
Dundalk, MD 21222-2104
Phone
(443) 721-7574
NPI assigned
Nov 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacqueline Ejim, LCPCNPI 1861920282
Title
Ceo/Director
Phone
(443) 721-7574

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X
Rehabilitation CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225C00000X

Addresses

Primary practice location

7544 Holabird Ave
Dundalk, MD 21222-2104

Mailing address

1281 Sugarwood Cir
Essex, MD 21221-5447
Phone (443) 721-7574

National Provider Directory

National Provider Directory
Tax ID family
Life of Abundance Behavioral Health Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7544 Holabird Ave
Dundalk, MD 21222
Phone (410) 282-9196

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1235773193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1281 SUGARWOOD CIR",
            "city": "ESSEX",
            "state": "MD",
            "postal_code": "212215447",
            "telephone_number": "443-721-7574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7544 HOLABIRD AVE",
            "city": "DUNDALK",
            "state": "MD",
            "postal_code": "212222104",
            "telephone_number": "443-721-7574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE OF ABUNDANCE BEHAVIORAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-04",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-26",
        "status": "A",
        "authorized_official_last_name": "EJIM",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "CEO/DIRECTOR",
        "authorized_official_telephone_number": "443-721-7574",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225C00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Rehabilitation Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dundalk, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.