Provider Demographics
NPI:1023628021
Name:VITA ABBODANTE LLC
Entity type:Organization
Organization Name:VITA ABBODANTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DORTHEA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:202-815-5525
Mailing Address - Street 1:8957 EDMONSTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4044
Mailing Address - Country:US
Mailing Address - Phone:202-815-5525
Mailing Address - Fax:
Practice Address - Street 1:8957 EDMONSTON RD STE C
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4044
Practice Address - Country:US
Practice Address - Phone:202-815-5525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty