Healthcare Provider Details

I. General information

NPI: 1902716947
Provider Name (Legal Business Name): HEALING WATERS COUNSELING & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 TRAIL CT
NEWARK OH
43055-9283
US

IV. Provider business mailing address

242 TRAIL CT
NEWARK OH
43055-9283
US

V. Phone/Fax

Practice location:
  • Phone: 248-716-8093
  • Fax:
Mailing address:
  • Phone: 248-716-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DESIREE WATERS
Title or Position: CLINICAL SOCIAL WORKER, OWNER
Credential: LISW
Phone: 248-716-8093