LIVING WATERS THERAPEUTIC ALLIANCE INC
NPI 1174207609
Counselor - Mental Health in Suffolk, VA
About Living Waters Therapeutic Alliance Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LIVING WATERS THERAPEUTIC ALLIANCE INC (NPI 1174207609) is a healthcare organization registered as a mental health in Suffolk, Virginia and active in the NPI registry since June 2023. The organization lists Charlena Judith Catherine Correll, Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Living Waters Therapeutic Alliance Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Living Waters Therapeutic Alliance Inc, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Living Waters Therapeutic Alliance Inc's NPI number?
The NPI number for Living Waters Therapeutic Alliance Inc is 1174207609. It was assigned to this organization in the NPPES registry on June 14, 2023.
Where is Living Waters Therapeutic Alliance Inc located?
Living Waters Therapeutic Alliance Inc is located at 2570 River Watch Dr, Suffolk, VA 23434. The listed phone number is (757) 270-3976.
What is Living Waters Therapeutic Alliance Inc's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Living Waters Therapeutic Alliance Inc enrolled in Medicare?
Yes. Living Waters Therapeutic Alliance Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Living Waters Therapeutic Alliance Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Mental Health Counselor) reassigns their Medicare billing to Living Waters Therapeutic Alliance Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Living Waters Therapeutic Alliance Inc was last updated on December 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Living Waters Therapeutic Alliance Inc · NPI 1174207609
Mental Health organization in Suffolk, Virginia. Organization record, active in the CMS NPPES registry since June 14, 2023.
## Identity
- **NPI:** 1174207609 (Entity type: Organization)
- **Enumerated:** June 14, 2023
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **Organization subpart:** No
- **Authorized official:** Charlena Correll, DIRECTOR
## Practice location
- **Address:** 2570 RIVER WATCH DR, Suffolk, VA 23434-8669
- **Phone:** (757) 270-3976
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Mental Health Counselor) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 2, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1174207609) · Data from the CMS NPPES public registry.