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General NPI Number Information
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NPI Number | 1376354654
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Entity Type | Organization
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Legal Business Name | PEACEFUL WAVES COUNSELING LLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 1027 W RUDISILL BLVD # 207
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City | FORT WAYNE
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State | IN
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Zip | 46807-2160
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Country | US
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Telephone | 260-225-3128
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Fax |
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Provider Business Mailing Address
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Address Line | 1027 W RUDISILL BLVD # 207
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City | FORT WAYNE
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State | IN
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Zip | 46807-2160
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER/OWNER
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Name | KAITLIN MARIE NINI
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Credential | MSSA, LCSW
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Telephone | 586-530-0735
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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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