Organization
LIFE ABUNDANT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE ELIZABETH WALL LCSW (OWNER)
(270) 792-9683
Entity
Organization
Contact information
Practice address
1830 DESTINY LN, SUITE105, BOWLING GREEN, KY 42104-1087
(270) 792-9683
Mailing address
1830 DESTINY LN, SUITE105, BOWLING GREEN, KY 42104-1087
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3483
KY
Other
Enumeration date
07/25/2016
Last updated
07/25/2016
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