Living Waters Therapeutic Alliance Inc

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

LIVING WATERS THERAPEUTIC ALLIANCE INC

Practice address

2570 River Watch Dr
Suffolk, VA 23434-8669

Phone

(757) 270-3976

NPI assigned

Jun 14, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Charlena Judith Catherine Correll, LPC, LCMHCNPI 1609531615

Title

Director

Phone

(757) 405-7519

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charlena Judith Catherine Correll, LPC

  • Professional Counselor
  • Chesapeake, VA
  • NPI 1609531615

  Mental Health

  Medicare reassignment NPD Authorized official
• Tara Elsenpeter, MSSW

  • Social Worker
  • Suffolk, VA
  • NPI 1841091642
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1174207609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 RIVER WATCH DR",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348669",
            "telephone_number": "757-270-3976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2570 RIVER WATCH DR",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348669",
            "telephone_number": "757-270-3976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WATERS THERAPEUTIC ALLIANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-14",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A",
        "authorized_official_last_name": "CORRELL",
        "authorized_official_first_name": "CHARLENA",
        "authorized_official_middle_name": "JUDITH CATHERINE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "757-405-7519",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC, LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Little Lifeline LLC
• Cynthia M. Little, WHNP-BC
• Living Beyond Home Health Care LLC
• Living Beyond Home Health Care LLC
• Living in Excellence. LLC
• Michael A Livoti, DPT
• Kristy Ellen Livsey, MA, LPC
• Leviticus Lofton, LCSW
• Logan and Lynn, LTD.
• Etienne Fox Logan II

• Mental Health Counselor in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.