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General NPI Number Information
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NPI Number | 1083100630
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Entity Type | Organization
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Legal Business Name | HEALING WATERS PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 10/11/2019
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Provider Practice Location Address
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Address Line | 966 HUNGERFORD DR STE 20A
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City | ROCKVILLE
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State | MD
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Zip | 20850-1741
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Country | US
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Telephone | 240-681-5058
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Fax |
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Provider Business Mailing Address
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Address Line | 966 HUNGERFORD DR STE 20A
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City | ROCKVILLE
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State | MD
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Zip | 20850-1741
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Country | US
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Telephone | 240-681-5058
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH S HENRICH
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Credential | LCSW-C
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Telephone | 240-681-5058
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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 | 14919
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License Number State | MD
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