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General NPI Number Information
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NPI Number | 1205604634
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Entity Type | Organization
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Legal Business Name | WATERSMEET WELLNESS LLC
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 33880 COMMUNITY COLLEGE DR STE 1
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City | SOLDOTNA
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State | AK
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Zip | 99669-9234
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Country | US
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Telephone | 833-973-0895
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Fax | 907-312-5847
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Provider Business Mailing Address
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Address Line | PO BOX 165
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City | KENAI
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State | AK
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Zip | 99611-0165
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Country | US
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Telephone | 907-690-3298
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Fax | 907-312-5847
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | MRS. CHRISTINA JOY STUIVE
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Credential | PHD
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Telephone | 833-973-0895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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