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General NPI Number Information
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NPI Number | 1194385401
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE COUNSELING AND WELLNESS GROUP
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 905 WALTON RD
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City | DIXON
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State | IL
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Zip | 61021-8347
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Country | US
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Telephone | 815-274-1293
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Fax |
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Provider Business Mailing Address
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Address Line | 905 WALTON RD
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City | DIXON
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State | IL
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Zip | 61021-8347
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Country | US
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Telephone | 815-274-1293
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KIMBERLY S DEVOS
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Credential | LCPC
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Telephone | 815-274-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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