Provider Demographics
NPI:1346259264
Name:WATERS, ANN CLAUDETTE (LPC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:CLAUDETTE
Last Name:WATERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3589 HABERSHAM AT NORTHLAKE
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:678-757-4453
Mailing Address - Fax:678-530-1034
Practice Address - Street 1:3589 HABERSHAM AT NORTHLAKE
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:678-757-4453
Practice Address - Fax:678-530-1034
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005573101Y00000X, 101YP2500X
GAAPC001330101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003245197AMedicaid