Healthcare Provider Details

I. General information

NPI: 1346874310
Provider Name (Legal Business Name): HEART OF ABUNDANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SOUTHERN AVE STE 2058
MESA AZ
85206-6217
US

IV. Provider business mailing address

3707 E SOUTHERN AVE STE 2058
MESA AZ
85206-6217
US

V. Phone/Fax

Practice location:
  • Phone: 480-678-6039
  • Fax:
Mailing address:
  • Phone: 480-678-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CANDICE DOGANS
Title or Position: THERAPIST, OWNER
Credential: LMFT, MAC
Phone: 480-678-6039