Healthcare Provider Details

I. General information

NPI: 1386196608
Provider Name (Legal Business Name): LIVING WATERS INTERNATIONAL MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 SW 30TH ST SUITE 201
DAVIE FL
33328-1979
US

IV. Provider business mailing address

1314 SW 160TH AVE
SUNRISE FL
33326-1907
US

V. Phone/Fax

Practice location:
  • Phone: 954-790-7707
  • Fax:
Mailing address:
  • Phone: 954-790-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberSW6661
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6661
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSW6661
License Number StateFL

VIII. Authorized Official

Name: MRS. CYNTHIA VALMONTE
Title or Position: MANAGING NURSE
Credential: RN
Phone: 954-790-7707