Provider Demographics
NPI:1578361689
Name:ABUNDANT LIVING COUNSELING LLC
Entity type:Organization
Organization Name:ABUNDANT LIVING COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR OF MENTAL HE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCMH, CCTP
Authorized Official - Phone:770-769-6264
Mailing Address - Street 1:4231 TATTNALL RUN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-9559
Mailing Address - Country:US
Mailing Address - Phone:770-769-6264
Mailing Address - Fax:
Practice Address - Street 1:4231 TATTNALL RUN
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9559
Practice Address - Country:US
Practice Address - Phone:770-769-6264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC0150637OtherGA STATE BOAR OF PROFESSIONAL LICENSING
DE1508537168Medicaid
DEPC-0011099OtherDIVISION OF PROFESSIONAL REGULATION