| Kingdom Source, Llc | |
|
2506 Johnston St Lafayette LA 70503-3238 | |
| (337) 456-6166 | |
| (337) 456-4830 |
| Full Name | Kingdom Source, Llc |
|---|---|
| Speciality | Counselor |
| Location | 2506 Johnston St, Lafayette, Louisiana |
| Authorized Official Name and Position | Winford Louis Amos (DIRECTOR/ OWNER) |
| Authorized Official Contact | 3374566166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kingdom Source, Llc 3226 Grand Point Hwy Breaux Bridge LA 70517-6221 Ph: (337) 456-6166 | Kingdom Source, Llc 2506 Johnston St Lafayette LA 70503-3238 Ph: (337) 456-6166 |
| NPI Number | 1154698892 |
|---|---|
| Provider Enumeration Date | 11/23/2011 |
| Last Update Date | 11/26/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154698892 | NPI | - | NPPES |
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