Provider Demographics
NPI:1053665471
Name:WATERS, MICHELLA MARIE (MSW,LCSWA)
Entity Type:Individual
Prefix:
First Name:MICHELLA
Middle Name:MARIE
Last Name:WATERS
Suffix:
Gender:F
Credentials:MSW,LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11018 POINT SOUTH DR
Mailing Address - Street 2:APT. I
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4561
Mailing Address - Country:US
Mailing Address - Phone:717-315-3024
Mailing Address - Fax:
Practice Address - Street 1:11018 POINT SOUTH DR
Practice Address - Street 2:APT. I
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4561
Practice Address - Country:US
Practice Address - Phone:717-315-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0071851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical