Provider Demographics
NPI:1811322928
Name:KINGDOM COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:KINGDOM COUNSELING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:SWAIN
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-515-0503
Mailing Address - Street 1:121 FARLEY BRANCH DRIVE
Mailing Address - Street 2:P.O. BOX 4614
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-0614
Mailing Address - Country:US
Mailing Address - Phone:434-515-0503
Mailing Address - Fax:434-237-0332
Practice Address - Street 1:121 FARLEY BRANCH DRIVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2363
Practice Address - Country:US
Practice Address - Phone:434-515-0503
Practice Address - Fax:434-237-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904007352251S00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty