Provider Demographics
NPI:1699514315
Name:LIVING WATERS AGENCY LLC
Entity type:Organization
Organization Name:LIVING WATERS AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:DILLON
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:828-610-1567
Mailing Address - Street 1:1111 WINDY HILL DR NW
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9095
Mailing Address - Country:US
Mailing Address - Phone:828-610-1567
Mailing Address - Fax:
Practice Address - Street 1:811 CONOVER BLVD W
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2919
Practice Address - Country:US
Practice Address - Phone:828-610-1567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty