Provider Demographics
NPI:1003197716
Name:KINGDOM DELIVERANCE MINISTRIES
Entity Type:Organization
Organization Name:KINGDOM DELIVERANCE MINISTRIES
Other - Org Name:KINGDOM COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPSC
Authorized Official - Phone:864-442-6282
Mailing Address - Street 1:910 PELZER HWY
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-2934
Mailing Address - Country:US
Mailing Address - Phone:864-280-9536
Mailing Address - Fax:
Practice Address - Street 1:910 PELZER HWY
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-2934
Practice Address - Country:US
Practice Address - Phone:864-442-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGDOM DELIVERANCE MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-08
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCL12327637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty