Provider Demographics
NPI:1174957823
Name:LIVING WATER COUNSELING CENTER INC
Entity type:Organization
Organization Name:LIVING WATER COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOTTON
Authorized Official - Suffix:III
Authorized Official - Credentials:LICSW, LADC1
Authorized Official - Phone:413-275-6368
Mailing Address - Street 1:94 SUFFOLK ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-4458
Mailing Address - Country:US
Mailing Address - Phone:413-315-3194
Mailing Address - Fax:413-315-8404
Practice Address - Street 1:476 APPLETON ST STE 2
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3236
Practice Address - Country:US
Practice Address - Phone:413-315-3194
Practice Address - Fax:413-322-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4TYZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health