Provider Demographics
NPI:1447790068
Name:CLEARWATER COUNSELING & WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:CLEARWATER COUNSELING & WELLNESS SERVICES, LLC
Other - Org Name:HEATHER KAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCP
Authorized Official - Phone:804-382-6546
Mailing Address - Street 1:530 E MAIN ST
Mailing Address - Street 2:SUITE 1012
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2418
Mailing Address - Country:US
Mailing Address - Phone:804-382-6546
Mailing Address - Fax:815-425-8519
Practice Address - Street 1:530 E MAIN ST
Practice Address - Street 2:SUITE 1012
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2418
Practice Address - Country:US
Practice Address - Phone:804-382-6546
Practice Address - Fax:815-425-8519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004995261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health