Healthcare Provider Details

I. General information

NPI: 1376407023
Provider Name (Legal Business Name): ROCK SOTERION KINGDOM COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 BROADWAY ST
HOUSTON TX
77087-4705
US

IV. Provider business mailing address

4101 BROADWAY ST
HOUSTON TX
77087-4705
US

V. Phone/Fax

Practice location:
  • Phone: 832-819-1096
  • Fax:
Mailing address:
  • Phone: 832-819-1096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANGELIC CHAISON
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: PH.D
Phone: 832-819-1096