Provider Demographics
NPI:1073746061
Name:LIVING WATERS INTERNATIONAL WOMEN'S MINISTRY
Entity Type:Organization
Organization Name:LIVING WATERS INTERNATIONAL WOMEN'S MINISTRY
Other - Org Name:LIVING WATERS INTERNATIONAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-577-4118
Mailing Address - Street 1:4780 W ANN RD STE 5-239
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3859
Mailing Address - Country:US
Mailing Address - Phone:702-577-4118
Mailing Address - Fax:702-925-4775
Practice Address - Street 1:4780 W ANN RD STE 5-239
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3859
Practice Address - Country:US
Practice Address - Phone:702-577-4118
Practice Address - Fax:702-925-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5312-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty