Provider Demographics
NPI:1235503178
Name:WATERS, WILLIAM (CADC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:WATERS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1935
Mailing Address - Country:US
Mailing Address - Phone:712-243-5091
Mailing Address - Fax:712-243-1337
Practice Address - Street 1:1500 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1935
Practice Address - Country:US
Practice Address - Phone:712-243-5091
Practice Address - Fax:712-243-1337
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09074101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA68236OtherWELLMARK
IA0177394Medicaid