Provider Demographics
NPI:1972980514
Name:LIVING WATER MINISTRIES INTERNATIONAL
Entity Type:Organization
Organization Name:LIVING WATER MINISTRIES INTERNATIONAL
Other - Org Name:LIVING WATER FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATONDRA
Authorized Official - Middle Name:CARLETTE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-614-7644
Mailing Address - Street 1:PO BOX 7563
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-7563
Mailing Address - Country:US
Mailing Address - Phone:318-614-7644
Mailing Address - Fax:318-342-9347
Practice Address - Street 1:1816 ROSELAWN AVENUE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-325-5898
Practice Address - Fax:318-342-9347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health