MEDICARE: THE HEALING WATERS COUNSELING WELLNESS CONSULTING & TRAINING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	0904003893	VA

General Provider Information

NPI Number	:	1417366527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEALING WATERS COUNSELING WELLNESS CONSULTING & TRAINING CENTER

Provider Business Mailing Address
First Line	:	867 WEYANOKE LN
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-9311
Country	:	US
Telephone Number	:	757-344-2294
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 MAIN ST
Second Line	:	SUITE 101
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-1090
Country	:	US
Telephone Number	:	757-344-2294
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CORNELIA AIDA BROWNING-MOORE
Credential	:	LCSW
Telephone Number	:	757-344-2294

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	08/04/2014

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