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General NPI Number Information
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NPI Number | 1659160323
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Entity Type | Organization
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Legal Business Name | STILL WATERS PSYCHIATRIC AND WELLNESS CENTER
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 5004 PRETTY WAY
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City | PANAMA CITY
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State | FL
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Zip | 32404-3089
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Country | US
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Telephone | 985-774-1497
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Fax |
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Provider Business Mailing Address
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Address Line | 4609 LINDSEY CROSSING PMB 222
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City | PANAMA CITY
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State | FL
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Zip | 32404
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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 | TITLE MGR
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Name | COLLEEN PAGOADA
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Credential | PMHNP-BC
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Telephone | 985-774-1497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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