Provider Demographics
NPI:1891491502
Name:KINGDOM COUNSELING
Entity Type:Organization
Organization Name:KINGDOM COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-971-0088
Mailing Address - Street 1:611 E THORN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-3527
Mailing Address - Country:US
Mailing Address - Phone:217-971-0088
Mailing Address - Fax:
Practice Address - Street 1:1301 ENTERPRISE WAY STE 50A
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4410
Practice Address - Country:US
Practice Address - Phone:217-971-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health