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General NPI Number Information
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NPI Number | 1538351903
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Entity Type | Organization
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Legal Business Name | KINGDOM MINISTRIES COUNSELING CENTER
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 8245 CORDOVA RD SUITE 100
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City | CORDOVA
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State | TN
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Zip | 38016-2086
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Country | US
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Telephone | 901-507-4519
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Fax | 901-881-6911
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Provider Business Mailing Address
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Address Line | 8245 CORDOVA RD SUITE 100
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City | CORDOVA
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State | TN
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Zip | 38016-2086
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Country | US
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Telephone | 901-507-4519
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Fax | 901-881-6911
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MISS ADDIE HALL GUINN
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Credential | MSSW
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Telephone | 901-507-4519
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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 | LCSW0000003139
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License Number State | TN
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