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General NPI Number Information
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NPI Number | 1124762083
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Entity Type | Organization
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Legal Business Name | LIVING WATERS COUNSELING AND WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 4920 WINDY HILL DR STE 14B
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City | RALEIGH
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State | NC
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Zip | 27609-5193
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Country | US
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Telephone | 984-212-4619
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Fax | 252-600-0454
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Provider Business Mailing Address
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Address Line | 3886 LITTLE CREEK CHURCH RD
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City | CLAYTON
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State | NC
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Zip | 27520-9536
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | AMANDA MBATA-GRAHAM
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Credential | LCSW
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Telephone | 919-521-2057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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