Provider Demographics
NPI:1245786557
Name:DARWIN P. CROSLAND / ABUNDANT LIFE SOCIAL SERVICES
Entity Type:Organization
Organization Name:DARWIN P. CROSLAND / ABUNDANT LIFE SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARWIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CROSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MC/MHC, CMHC
Authorized Official - Phone:801-436-4500
Mailing Address - Street 1:2813 S 2400 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8669
Mailing Address - Country:US
Mailing Address - Phone:801-436-4500
Mailing Address - Fax:
Practice Address - Street 1:2813 S 2400 W
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-8669
Practice Address - Country:US
Practice Address - Phone:801-436-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT283932-6004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health