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General NPI Number Information
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NPI Number | 1891094421
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Entity Type | Organization
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Legal Business Name | KINGDOM REALITY HEALING & COUNSELING CENTER
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 3610 CENTRAL AVE STE 208
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City | RIVERSIDE
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State | CA
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Zip | 92506-5905
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Country | US
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Telephone | 909-894-6335
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12093
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-2093
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Country | US
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Telephone | 909-894-6335
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Fax |
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Authorized Official
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Title or Position | MARRIAGE & FAMILY THERAPIST/FOUNDER
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Name | MISS NAHOMIE MOISE
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Credential | LMFT
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Telephone | 909-894-6335
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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 | MFC48571
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License Number State | CA
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