Living Waters Agency LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

LIVING WATERS AGENCY LLC

Practice address

811 Conover Blvd W
Conover, NC 28613-2919

Phone

(828) 610-1567

NPI assigned

May 22, 2024

Organization subpart

No

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

Authorized official

Name

Karen Dillon Hernandez, LCMHCNPI 1710435516

Title

Owner/Therapy

Phone

(828) 610-1567

Specialties & licenses 3

Addresses

Locations

Practitioners 1

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

• Karen Dillon Hernandez, MA, LCAS, LCMHCA, NC

  • Professional Counselor
  • Conover, NC
  • NPI 1710435516

  Addiction (Substance Use Disorder)

  NPD Authorized official

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

{
    "created_epoch": "1716336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1699514315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 WINDY HILL DR NW",
            "city": "CONOVER",
            "state": "NC",
            "postal_code": "286139095",
            "telephone_number": "828-610-1567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 CONOVER BLVD W",
            "city": "CONOVER",
            "state": "NC",
            "postal_code": "286132919",
            "telephone_number": "828-610-1567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WATERS AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-22",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "DILLON",
        "authorized_official_title_or_position": "OWNER/THERAPY",
        "authorized_official_telephone_number": "828-610-1567",
        "authorized_official_credential": "LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Conover, NC
• Providers in Conover, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.