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General NPI Number Information
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NPI Number | 1841899671
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Entity Type | Organization
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Legal Business Name | LIVING WATERS COUNSELING AND CONSULTING SERVICES NFP
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 4550 W 103RD ST STE 302B
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City | OAK LAWN
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State | IL
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Zip | 60453-4868
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Country | US
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Telephone | 773-280-5675
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Fax | 773-873-5333
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Provider Business Mailing Address
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Address Line | 8157 S ELIZABETH ST
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City | CHICAGO
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State | IL
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Zip | 60620-3857
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Country | US
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Telephone | 708-271-5370
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Fax | 773-873-5333
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. RENEE LEE
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Credential | LCSW, CADC
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Telephone | 708-271-5370
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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 | 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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