Provider Demographics
NPI:1629370515
Name:LIBERATING LIVES: CHRISTIAN COUNSELING & PSYCHOL
Entity Type:Organization
Organization Name:LIBERATING LIVES: CHRISTIAN COUNSELING & PSYCHOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:757-449-3671
Mailing Address - Street 1:420 N CENTER DR
Mailing Address - Street 2:BLDG 11, SUITE 113
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4007
Mailing Address - Country:US
Mailing Address - Phone:757-449-3671
Mailing Address - Fax:
Practice Address - Street 1:420 N CENTER DR
Practice Address - Street 2:BLDG 11, SUITE 113
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4007
Practice Address - Country:US
Practice Address - Phone:757-449-3671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-26
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA071003632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty