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Organization

KINGDOM SOURCE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WINFORD LOUIS AMOS LPC, LAC, CCS (DIRECTOR/ OWNER)
(337) 456-6166
Entity
Organization

Contact information

Practice address
2506 JOHNSTON ST, LAFAYETTE, LA 70503-3238
(337) 456-6166
(337) 456-4830
Mailing address
3226 GRAND POINT HWY, BREAUX BRIDGE, LA 70517-6221
(337) 456-6166
(337) 456-4830

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
101YP1600X
Pastoral Counselor
101YP2500X
Professional Counselor
104100000X
Social Worker

Other

Enumeration date
11/23/2011
Last updated
11/26/2019
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