Healthcare Provider Details

I. General information

NPI: 1902741341
Provider Name (Legal Business Name): WAVES TO SHORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 7TH ST NW
WASHINGTON DC
20011-4049
US

IV. Provider business mailing address

4830 7TH ST NW
WASHINGTON DC
20011-4049
US

V. Phone/Fax

Practice location:
  • Phone: 240-461-9349
  • Fax:
Mailing address:
  • Phone: 240-461-9349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KALLIROI MATSAKIS
Title or Position: OWNER
Credential: LICSW
Phone: 240-461-9349