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General NPI Number Information
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NPI Number | 1386196608
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Entity Type | Organization
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Legal Business Name | LIVING WATERS INTERNATIONAL MINISTRIES
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 7950 SW 30TH ST SUITE 201
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City | DAVIE
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State | FL
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Zip | 33328-1979
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Country | US
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Telephone | 954-790-7707
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 SW 160TH AVE
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City | SUNRISE
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State | FL
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Zip | 33326-1907
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Country | US
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Telephone | 954-790-7707
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Fax |
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Authorized Official
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Title or Position | MANAGING NURSE
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Name | MRS. CYNTHIA VALMONTE
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Credential | RN
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Telephone | 954-790-7707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | SW6661
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW6661
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SW6661
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License Number State | FL
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