Provider Demographics
NPI:1891094421
Name:KINGDOM REALITY HEALING & COUNSELING CENTER
Entity Type:Organization
Organization Name:KINGDOM REALITY HEALING & COUNSELING CENTER
Other - Org Name:KRHCC
Other - Org Type:Other Name
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST/FOUNDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NAHOMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-894-6335
Mailing Address - Street 1:PO BOX 12093
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-2093
Mailing Address - Country:US
Mailing Address - Phone:909-894-6335
Mailing Address - Fax:
Practice Address - Street 1:3610 CENTRAL AVE STE 208
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5905
Practice Address - Country:US
Practice Address - Phone:909-894-6335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48571251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health