Provider Demographics
NPI:1659744829
Name:ABUNDANT LIFE COUNSELING
Entity Type:Organization
Organization Name:ABUNDANT LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CAPPARUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:404-788-0002
Mailing Address - Street 1:2904 ARABIAN PL NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4631
Mailing Address - Country:US
Mailing Address - Phone:404-788-0002
Mailing Address - Fax:
Practice Address - Street 1:4343 SHALLOWFORD RD
Practice Address - Street 2:BUILDING C2
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5023
Practice Address - Country:US
Practice Address - Phone:404-788-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008633251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health