Healthcare Provider Details

I. General information

NPI: 1982234092
Provider Name (Legal Business Name): CALM WATERS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E MAIN ST STE 216
RICHMOND VA
23223-7073
US

IV. Provider business mailing address

3024 CONE MANOR LN
RALEIGH NC
27613-6604
US

V. Phone/Fax

Practice location:
  • Phone: 510-776-3984
  • Fax: 888-519-4656
Mailing address:
  • Phone: 510-776-3984
  • Fax: 888-519-4656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MARLIN A METTERS
Title or Position: OWNER
Credential:
Phone: 510-776-3984