Provider Demographics
NPI:1508282336
Name:ABUNDANT WELLNESS, PLLC
Entity Type:Organization
Organization Name:ABUNDANT WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:586-914-5914
Mailing Address - Street 1:813 CRESCENT LN
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2701
Mailing Address - Country:US
Mailing Address - Phone:586-914-5914
Mailing Address - Fax:313-458-7128
Practice Address - Street 1:23409 JEFFERSON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3449
Practice Address - Country:US
Practice Address - Phone:586-914-5914
Practice Address - Fax:313-458-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801906771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty