Provider Demographics
NPI:1356951263
Name:LIVING IN ABUNDANCE
Entity type:Organization
Organization Name:LIVING IN ABUNDANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:248-252-9306
Mailing Address - Street 1:PO BOX 47883
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-5583
Mailing Address - Country:US
Mailing Address - Phone:248-252-9306
Mailing Address - Fax:
Practice Address - Street 1:24801 5 MILE RD STE 21
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3654
Practice Address - Country:US
Practice Address - Phone:248-819-0553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty