Provider Demographics
NPI:1538351903
Name:KINGDOM MINISTRIES COUNSELING CENTER
Entity type:Organization
Organization Name:KINGDOM MINISTRIES COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:GUINN
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:901-507-4519
Mailing Address - Street 1:8245 CORDOVA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2086
Mailing Address - Country:US
Mailing Address - Phone:901-507-4519
Mailing Address - Fax:901-881-6911
Practice Address - Street 1:8245 CORDOVA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2086
Practice Address - Country:US
Practice Address - Phone:901-507-4519
Practice Address - Fax:901-881-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW00000031391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4136024OtherBCBSTN
TN600014OtherMAGELLAN
TN4147539OtherBCBSTN
TN599764OtherMAGELLAN
TN599764OtherMAGELLAN