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General NPI Number Information
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NPI Number | 1922445535
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Entity Type | Organization
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Legal Business Name | LIVING WATER COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 94 SUFFOLK ST
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City | HOLYOKE
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State | MA
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Zip | 01040-4458
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Country | US
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Telephone | 413-315-3194
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Fax | 413-322-8404
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Provider Business Mailing Address
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Address Line | 94 SUFFOLK ST
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City | HOLYOKE
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State | MA
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Zip | 01040-4458
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Country | US
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Telephone | 413-315-3194
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Fax | 413-322-8404
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FRANK H WOTTON III
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Credential | LICSE, LADC 1
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Telephone | 413-315-3194
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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 | 114516
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License Number State | MA
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