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General NPI Number Information
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NPI Number | 1487123451
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Entity Type | Organization
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Legal Business Name | HEALING WATERS OUTREACH MINISTRIES
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 1547 GENESEE ST
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City | BUFFALO
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State | NY
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Zip | 14211-1632
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Country | US
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Telephone | 716-725-0561
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Fax |
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Provider Business Mailing Address
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Address Line | 1547 GENESEE ST
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City | BUFFALO
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State | NY
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Zip | 14211-1632
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Country | US
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Telephone | 716-725-0561
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. BENITA HOWELL-ISRAEL
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Credential | CERT.RECOVERY COACH
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Telephone | 160-717-6839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 177F00000X
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Taxonomy Name | Lodging Provider
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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 | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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