Provider Demographics
NPI:1508401258
Name:LIVING WATER COUNSELING LLC
Entity Type:Organization
Organization Name:LIVING WATER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:CUNLIFFE
Authorized Official - Last Name:DE MELKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC, LPC
Authorized Official - Phone:443-553-7317
Mailing Address - Street 1:506 COUNTERPOINT CIR
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2691
Mailing Address - Country:US
Mailing Address - Phone:443-553-7317
Mailing Address - Fax:
Practice Address - Street 1:3522 SILVERSIDE RD STE 32
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4915
Practice Address - Country:US
Practice Address - Phone:443-553-7317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty