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General NPI Number Information
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NPI Number | 1942631635
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Entity Type | Organization
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Legal Business Name | HEALING WATERS COUNSELING, LLC
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 4320 RINGGOLD RD SUITE ONE
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City | EAST RIDGE
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State | TN
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Zip | 37412-2712
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Country | US
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Telephone | 423-698-5090
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Fax | 423-698-5090
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Provider Business Mailing Address
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Address Line | 4320 RINGGOLD RD SUITE ONE
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City | EAST RIDGE
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State | TN
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Zip | 37412-2712
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Country | US
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Telephone | 423-698-5090
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Fax | 423-698-5090
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Authorized Official
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Title or Position | OWNER
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Name | MR. TED R WILKES JR.
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Credential |
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Telephone | 423-698-5090
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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 | 048009
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License Number State | TN
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