Provider Demographics
NPI:1083100630
Name:HEALING WATERS PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:HEALING WATERS PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:HENRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-681-5058
Mailing Address - Street 1:966 HUNGERFORD DR STE 20A
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1741
Mailing Address - Country:US
Mailing Address - Phone:240-681-5058
Mailing Address - Fax:
Practice Address - Street 1:966 HUNGERFORD DR STE 20A
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1741
Practice Address - Country:US
Practice Address - Phone:240-681-5058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD600958728OtherMAGELLAN
MD214235000Medicaid
MD4942002OtherCIGNA
MDCL110001OtherCAREFIRST
MD4870243OtherAETNA