=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639906530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENTLE WATERS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2024
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 149 CREEKSIDE LN STE B
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22602-2447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-692-0225
-----------------------------------------------------
Fax | 540-301-8871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95 PARK WAY
-----------------------------------------------------
City | FRONT ROYAL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22630-5014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-692-0225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | DEVENEY QUINNEY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 540-692-0225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------