Organization
ABUNDANT LIFE THERAPEUTIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELVIN L ANDERSON (EXECUTIVE DIRECTOR)
(757) 616-0657
Entity
Organization
Contact information
Practice address
645 CHURCH ST., SUITE 104C, NORFOLK, VA 23510
(757) 616-0657
(757) 533-9369
Mailing address
645 CHURCH ST, SUITE 104C, NORFOLK, VA 23510-1712
(757) 616-0657
(757) 533-9369
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
2154
VA
Other
Enumeration date
07/22/2013
Last updated
06/05/2015
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