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General NPI Number Information
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NPI Number | 1417366527
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Entity Type | Organization
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Legal Business Name | THE HEALING WATERS COUNSELING WELLNESS CONSULTING & TRAINING CENTER
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 809 MAIN ST SUITE 101
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City | NEWPORT NEWS
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State | VA
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Zip | 23605-1090
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Country | US
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Telephone | 757-344-2294
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Fax |
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Provider Business Mailing Address
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Address Line | 867 WEYANOKE LN
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-9311
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Country | US
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Telephone | 757-344-2294
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CORNELIA AIDA BROWNING-MOORE
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Credential | LCSW
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Telephone | 757-344-2294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0904003893
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License Number State | VA
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