Provider Demographics
NPI:1245919430
Name:ABUNDANT LIFE PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:ABUNDANT LIFE PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RACADAG
Authorized Official - Suffix:
Authorized Official - Credentials:BSN-RN
Authorized Official - Phone:706-613-4485
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-0030
Mailing Address - Country:US
Mailing Address - Phone:706-613-4485
Mailing Address - Fax:
Practice Address - Street 1:95 GOLDEN HILLS DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:MOUNTAIN CITY
Practice Address - State:GA
Practice Address - Zip Code:30562
Practice Address - Country:US
Practice Address - Phone:706-613-4485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)