# LIFE ABUNDANT CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063965242
- **Authorized official:** JAMIE ELIZABETH WALL LCSW (OWNER)
- **Authorized official phone:** (270) 792-9683

## Contact information

- **Practice address:** 1830 DESTINY LN, SUITE105, BOWLING GREEN, KY 42104-1087
- **Practice address phone:** (270) 792-9683
- **Mailing address:** 1830 DESTINY LN, SUITE105, BOWLING GREEN, KY 42104-1087

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 3483 | KY | Yes |

## Other

- **Enumeration date:** 07/25/2016
- **Last updated:** 07/25/2016