Organization · NPI-2

Abundant Life Counseling LLC

Social Worker, Clinical · Waterbury, CT

NPI number1467998674
StatusActive
Last updated in NPPESNov 28, 2023

Details

NPI
1467998674
Entity type
Organization (NPI-2)
Legal business name
Abundant Life Counseling LLC
Organization subpart
No
Enumeration date
Jan 11, 2017
Certification date
Nov 28, 2023
Last updated
Nov 28, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1041C0700X Social Worker, Clinical008874CTYes
101YA0400X Counselor, Addiction (Substance Use Disorder)––
101YP2500X Counselor, Professional––
1041C0700X Social Worker, Clinical––
251S00000X Community/Behavioral Health008874CT
363LP0808X Nurse Practitioner, Psych/Mental Health––

Practice location

21 W Main St Fl 4
Waterbury, CT 06702-2013

Phone 203-317-3333 · Fax 203-841-0304

Mailing address

21 W Main St Fl 4
Waterbury, CT 06702-2013

Phone 203-317-3333

Authorized official

Lillian Lashae Outlaw
Owner
2033173333

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