Healthcare Provider Details

I. General information

NPI: 1497590400
Provider Name (Legal Business Name): HEALING WATERS RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 BEVIS AVE
CINCINNATI OH
45207-1609
US

IV. Provider business mailing address

3331 BEVIS AVE
CINCINNATI OH
45207-1609
US

V. Phone/Fax

Practice location:
  • Phone: 513-518-5596
  • Fax:
Mailing address:
  • Phone: 513-518-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL COLLINS
Title or Position: PRESIDENT
Credential: LPCC LICDC
Phone: 513-518-5596