Provider Demographics
NPI:1225675317
Name:BLUE WATER COUNSELING AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:BLUE WATER COUNSELING AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRNOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-652-1091
Mailing Address - Street 1:101 BASSETT DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-5409
Mailing Address - Country:US
Mailing Address - Phone:603-652-1091
Mailing Address - Fax:
Practice Address - Street 1:835 CENTRAL AVE STE 126
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2506
Practice Address - Country:US
Practice Address - Phone:603-652-1091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty