Provider Demographics
NPI:1194385401
Name:ABUNDANT LIFE COUNSELING AND WELLNESS GROUP
Entity Type:Organization
Organization Name:ABUNDANT LIFE COUNSELING AND WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEVOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-274-1283
Mailing Address - Street 1:23665 W DUPAGE COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-9221
Mailing Address - Country:US
Mailing Address - Phone:815-274-1293
Mailing Address - Fax:
Practice Address - Street 1:15255 S 94TH AVE STE 500
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3895
Practice Address - Country:US
Practice Address - Phone:815-274-1293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health