Provider Demographics
NPI:1225777840
Name:WAVES TO NIRVANA, LLC
Entity Type:Organization
Organization Name:WAVES TO NIRVANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, MS
Authorized Official - Phone:410-707-5684
Mailing Address - Street 1:412 OVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1803
Mailing Address - Country:US
Mailing Address - Phone:410-707-5684
Mailing Address - Fax:
Practice Address - Street 1:744 DULANEY VALLEY RD STE 3
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5132
Practice Address - Country:US
Practice Address - Phone:410-707-5684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty