Provider Demographics
NPI:1861985327
Name:ABUNDANT LIFE CHRISTIAN COUNSELING INC
Entity type:Organization
Organization Name:ABUNDANT LIFE CHRISTIAN COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEJIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-383-2278
Mailing Address - Street 1:54 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-8399
Mailing Address - Country:US
Mailing Address - Phone:770-383-2278
Mailing Address - Fax:
Practice Address - Street 1:251 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2206
Practice Address - Country:US
Practice Address - Phone:770-383-2278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty