Provider Demographics
NPI:1043609654
Name:ABUNDANCE OF LIFE NETWORK
Entity Type:Organization
Organization Name:ABUNDANCE OF LIFE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/C.E.O
Authorized Official - Prefix:MS
Authorized Official - First Name:GAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:706-553-1318
Mailing Address - Street 1:141 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-7204
Mailing Address - Country:US
Mailing Address - Phone:706-553-1318
Mailing Address - Fax:
Practice Address - Street 1:100 HARTSFIELD CENTER PKWY STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-1377
Practice Address - Country:US
Practice Address - Phone:706-553-1318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty