| Organization Name: | KINGDOM SOURCE, LLC |
| NPI Number: | 1154698892 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WINFORD LOUIS AMOS (DIRECTOR/ OWNER) |
| Mailing Address: | 1105 General Mouton Avenue Lafayette |
| State: | LA US |
| Postal Code: | 705018529 |
| Phone Number: | 3374566166 |
| Fax Number: | 3374564830 |
| NPI Enumeration Date: | 11/23/2011 |
| NPI Last Update Date: | 11/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 1204 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |