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General NPI Number Information
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NPI Number | 1356020861
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Entity Type | Organization
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Legal Business Name | TRANQUIL WATERS, LLC
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 191 SPROUSE DR
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City | AMHERST
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State | VA
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Zip | 24521-3360
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Country | US
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Telephone | 434-509-8588
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Fax |
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Provider Business Mailing Address
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Address Line | 191 SPROUSE DR
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City | AMHERST
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State | VA
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Zip | 24521-3360
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Country | US
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Telephone | 434-509-8588
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Fax |
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Authorized Official
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Title or Position | RESIDENT IN COUNSELING
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Name | JAJUAN THOMAS
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Credential | LMHP-R
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Telephone | 434-509-8588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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