Healthcare Provider Details

I. General information

NPI: 1154848067
Provider Name (Legal Business Name): WAVES COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 N HIGHWAY 27
CARROLLTON GA
30117
US

IV. Provider business mailing address

856 OLD ANTIOCH RD
CARROLLTON GA
30117-7837
US

V. Phone/Fax

Practice location:
  • Phone: 470-244-2574
  • Fax: 678-890-1518
Mailing address:
  • Phone: 970-682-9097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW60265
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW.09923102
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW11578
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW005581
License Number StateGA

VIII. Authorized Official

Name: MRS. DANYALE WEEMS
Title or Position: CEO/FOUNDER
Credential: LCSW
Phone: 470-244-2574