Healthcare Provider Details

I. General information

NPI: 1508571670
Provider Name (Legal Business Name): WATERS EDGE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 DONNER TRL
RIVERBANK CA
95367-9578
US

IV. Provider business mailing address

PO BOX 116
RIVERBANK CA
95367-0116
US

V. Phone/Fax

Practice location:
  • Phone: 443-579-4714
  • Fax:
Mailing address:
  • Phone: 443-579-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. IESHA FELTON-WATERS
Title or Position: OWNER
Credential: LCPC, LPCC, NCC
Phone: 443-579-4714