Provider Demographics
NPI:1023188406
Name:WATERS, BETH ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:WATERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LUCKETTS CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-8426
Mailing Address - Country:US
Mailing Address - Phone:540-903-0839
Mailing Address - Fax:
Practice Address - Street 1:18 LUCKETTS CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-8426
Practice Address - Country:US
Practice Address - Phone:540-903-0839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA237888OtherANTHEN BCBS