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General NPI Number Information
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NPI Number | 1053116897
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Entity Type | Organization
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Legal Business Name | CALM WATERS COLLECTIVE LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 7901 4TH ST N # 25524
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 321-501-1770
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Fax |
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Provider Business Mailing Address
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Address Line | 1558 MEADOW LARK DR
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City | TITUSVILLE
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State | FL
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Zip | 32780-7919
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Country | US
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Telephone | 321-501-1770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA SARKEES DACKO
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Credential | LCSW
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Telephone | 321-501-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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