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Organization

LIVING WATER COUNSELING CENTER, INC.

Active
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Organization

LIVING WATER COUNSELING CENTER, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. FRANK H WOTTON III LICSE, LADC 1 (PRESIDENT)
(413) 315-3194
Entity
Organization

Contact information

Practice address
94 SUFFOLK ST, HOLYOKE, MA 01040-4458
(413) 315-3194
(413) 322-8404
Mailing address
94 SUFFOLK ST, HOLYOKE, MA 01040-4458
(413) 315-3194
(413) 322-8404

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
114516
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0005602
MEDICARE
MA
01
109497
BEACON
MA
01
241903
TUFT
MA
01
45208
HEALTH NEW ENGLAND
MA
01
6724849
AETNA
MA
01
P09114
BLUE CROSS BLUE SHIELD
MA
Enumeration date
05/23/2013
Last updated
05/23/2013
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