1750552915 NPI number — ABUNDANT LIFE COUNSELING SERVICE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750552915 NPI number — ABUNDANT LIFE COUNSELING SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABUNDANT LIFE COUNSELING SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750552915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 OLD HICKORY BLVD
Provider Second Line Business Mailing Address:
TWO BRENTWOOD COMMONS SUITE 150
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-371-6107
Provider Business Mailing Address Fax Number:
615-369-6207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 OLD HICKORY BLVD
Provider Second Line Business Practice Location Address:
TWO BRENTWOOD COMMONS SUITE 150
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-371-6107
Provider Business Practice Location Address Fax Number:
615-369-6207
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
615-371-6107

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LSW0000004454 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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