Healthcare Provider Details

I. General information

NPI: 1831254978
Provider Name (Legal Business Name): CAROL A WATERS MA, LPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N MAPLE ST
ITHACA MI
48847-1024
US

IV. Provider business mailing address

5131 CORVALLIS DR
MOUNT PLEASANT MI
48858-7935
US

V. Phone/Fax

Practice location:
  • Phone: 989-388-4185
  • Fax: 989-388-4187
Mailing address:
  • Phone: 989-289-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010542
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: