Healthcare Provider Details

I. General information

NPI: 1154676260
Provider Name (Legal Business Name): KINGDOM KOUNSEL, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MONARCH AVE
BATON ROUGE LA
70811-5628
US

IV. Provider business mailing address

9054 SCOTLAND AVE
BATON ROUGE LA
70807-4244
US

V. Phone/Fax

Practice location:
  • Phone: 225-405-2209
  • Fax:
Mailing address:
  • Phone: 225-405-2209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name: CHRISTI HUNTER BROWN
Title or Position: CEO
Credential:
Phone: 225-405-2209