Healthcare Provider Details

I. General information

NPI: 1982385670
Provider Name (Legal Business Name): CALM WATERS WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 APOLLO BEACH BLVD STE B
APOLLO BEACH FL
33572-3037
US

IV. Provider business mailing address

11608 CREST CREEK DR
RIVERVIEW FL
33569-2050
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-2234
  • Fax:
Mailing address:
  • Phone: 813-841-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERICA NICOLE WOOTEN
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 813-444-2234