Provider Demographics
NPI:1124329388
Name:HEALING WATERS COUNSELING CENTER
Entity type:Organization
Organization Name:HEALING WATERS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CSAC
Authorized Official - Phone:276-963-0111
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-0426
Mailing Address - Country:US
Mailing Address - Phone:276-963-0111
Mailing Address - Fax:276-963-0005
Practice Address - Street 1:1113 CEDAR VALLEY DR.
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609
Practice Address - Country:US
Practice Address - Phone:276-963-0111
Practice Address - Fax:276-963-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty