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General NPI Number Information
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NPI Number | 1376893453
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Entity Type | Individual
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Provider Name | JESSICA M WATERS
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Gender | Female
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 439 CHURCHILL CT
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City | KISSIMMEE
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State | FL
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Zip | 34759-5950
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Country | US
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Telephone | 407-963-7434
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Fax |
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Provider Business Mailing Address
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Address Line | 200 WILSON POINT RD UNIT 4913
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-7601
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Country | US
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Telephone | 410-702-8864
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LGP10554
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License Number State | MD
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