Healthcare Provider Details

I. General information

NPI: 1124329388
Provider Name (Legal Business Name): HEALING WATERS COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 SUFFOLK AVE STE 1
RICHLANDS VA
24641-2434
US

IV. Provider business mailing address

PO BOX 426
CEDAR BLUFF VA
24609-0426
US

V. Phone/Fax

Practice location:
  • Phone: 276-821-2260
  • Fax:
Mailing address:
  • Phone: 276-963-0111
  • Fax: 276-963-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. BRADLEY TODD KINDER
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: M.S., LPC, CSAC
Phone: 276-963-0111