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General NPI Number Information
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NPI Number | 1659162477
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Entity Type | Organization
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Legal Business Name | WAVES OF WELLNESS THERAPY LLC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 300 CHARLES ST STE 5
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City | LA PLATA
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State | MD
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Zip | 20646-3582
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Country | US
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Telephone | 240-776-2941
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 181
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City | BENEDICT
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State | MD
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Zip | 20612-0181
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Country | US
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Telephone | 240-776-2941
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST/OWNER
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Name | KIMBERLY GARNER
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Credential | LCSW-C
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Telephone | 240-776-2941
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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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