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General NPI Number Information
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NPI Number | 1407621998
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Entity Type | Organization
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Legal Business Name | LIFE KINGDOM OUTREACH MINISTRIES, INC.
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 1570 CHAPEL ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-4251
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Country | US
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Telephone | 203-999-8734
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 CHAPEL ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-4251
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Country | US
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Telephone | 203-999-8734
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. GERALDINE HANDY-MORRIS
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Credential |
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Telephone | 203-999-8734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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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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