Healthcare Provider Details

I. General information

NPI: 1588589915
Provider Name (Legal Business Name): WAVES OF HOPE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2822 SAINT MARYS RD
SAINT MARYS GA
31558-4559
US

IV. Provider business mailing address

2822 SAINT MARYS RD
SAINT MARYS GA
31558-4559
US

V. Phone/Fax

Practice location:
  • Phone: 904-530-1415
  • Fax: 912-222-3761
Mailing address:
  • Phone: 912-222-3761
  • Fax: 912-222-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN LEIGH PHILLIPS
Title or Position: OWNER, CLINICIAN
Credential: LCSW
Phone: 912-222-3761