Active NPI
Life of Abundance Behavioral Health Services LLC
- Community/Behavioral Health Agency
- Rosedale, MD
National Provider Identifier
1881260263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- LIFE OF ABUNDANCE BEHAVIORAL HEALTH SERVICES LLC
- Practice address
- 6918 Ridge Rd
Rosedale, MD 21237-3854 - Phone
- (443) 731-2349
- Fax
- (443) 874-1347
- NPI assigned
- May 27, 2021
- Organization subpart
- Yes
- Parent organization
- LIFE OF ABUNDANCE PRP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Jacqueline Ejim, LCPC
- Title
- Ceo/Clinical Director
- Phone
- (443) 731-2349
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
6918 Ridge Rd
Rosedale, MD 21237-3854
Mailing address
6918 Ridge Road
Rosedale, MD 21237
Phone (443) 721-7574
Other names 1
- Life of Abundance Behavioral Health
National Provider Directory
National Provider Directory- Tax ID family
- Life of Abundance Behavioral Health Services LLC
- Part of
- Life of Abundance Behavioral Health Services LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Counselor
- Dundalk, MD
- NPI 1235773193
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Professional Counselor
- Baltimore, MD
- NPI 1861920282
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622073600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1623801600000",
"number": "1881260263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6918 RIDGE ROAD",
"city": "ROSEDALE",
"state": "MD",
"postal_code": "21237",
"telephone_number": "443-721-7574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6918 RIDGE RD",
"city": "ROSEDALE",
"state": "MD",
"postal_code": "212373854",
"telephone_number": "443-731-2349",
"fax_number": "443-874-1347"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LIFE OF ABUNDANCE BEHAVIORAL HEALTH SERVICES LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LIFE OF ABUNDANCE PRP",
"enumeration_date": "2021-05-27",
"last_updated": "2021-06-16",
"certification_date": "2021-06-16",
"status": "A",
"authorized_official_last_name": "EJIM",
"authorized_official_first_name": "JACQUELINE",
"authorized_official_title_or_position": "CEO/CLINICAL DIRECTOR",
"authorized_official_telephone_number": "443-731-2349",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "LCPC"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Life of Abundance Behavioral Health",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "Life of Abundance Behavioral Health",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Rosedale, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.