Provider Demographics
NPI:1457865941
Name:ABUNDANT LIFE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ABUNDANT LIFE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-896-2124
Mailing Address - Street 1:1975 BRAYTON CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9015
Mailing Address - Country:US
Mailing Address - Phone:770-896-2124
Mailing Address - Fax:
Practice Address - Street 1:445 WINDY HILL RD SE STE 223
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7352
Practice Address - Country:US
Practice Address - Phone:770-896-2124
Practice Address - Fax:770-896-2124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABUNDANT LIFE COUNSELING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty