Provider Demographics
NPI:1003481706
Name:ABUNDANT LIFE CENTERS LLC
Entity Type:Organization
Organization Name:ABUNDANT LIFE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-345-6831
Mailing Address - Street 1:PO BOX 121196
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32912-1196
Mailing Address - Country:US
Mailing Address - Phone:321-345-6831
Mailing Address - Fax:
Practice Address - Street 1:2475 PALM BAY RD NE STE 145-23
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3317
Practice Address - Country:US
Practice Address - Phone:321-345-6831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty