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NPI Code Detail

MEDICARE: MICHELLE L WATERS CDCA

MEDICARE: MICHELLE L WATERS CDCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.168924OH

General Provider Information

NPI Number : 1023580743
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE L WATERS CDCA
Provider Business Mailing Address
First Line : 77 E WOODBURY DR STE 110
Second Line :
City : DAYTON
State : OH
Zip : 45415-2853
Country : US
Telephone Number : 937-373-7848
Fax Number :
Provider Business Practice Location Address
First Line : 77 E WOODBURY DR STE 110
Second Line :
City : DAYTON
State : OH
Zip : 45415-2853
Country : US
Telephone Number : 937-373-7848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2018
Last Update Date : 10/08/2025

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Directions to “ MICHELLE L WATERS CDCA” Practice Location

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