MEDICARE: LIVING IN ABUNDANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1356951263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING IN ABUNDANCE

Provider Business Mailing Address
First Line	:	PO BOX 47883
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-5583
Country	:	US
Telephone Number	:	248-252-9306
Fax Number	:

Provider Business Practice Location Address
First Line	:	24801 5 MILE RD STE 21
Second Line	:
City	:	REDFORD
State	:	MI
Zip	:	48239-3654
Country	:	US
Telephone Number	:	248-819-0553
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LIA M HOLLIS
Credential	:	LCSW
Telephone Number	:	248-252-9306

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	08/05/2020

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Directions to “LIVING IN ABUNDANCE ” Practice Location

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