Provider Demographics
NPI:1154863140
Name:ABUNDANT LIFE COUNSELING AND SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:ABUNDANT LIFE COUNSELING AND SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SOLANGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-248-5667
Mailing Address - Street 1:4899 FINLAY STREET
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2858
Mailing Address - Country:US
Mailing Address - Phone:804-922-3740
Mailing Address - Fax:804-222-3737
Practice Address - Street 1:4899 FINLAY ST
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-2858
Practice Address - Country:US
Practice Address - Phone:804-922-3740
Practice Address - Fax:804-222-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty