Provider Demographics
NPI:1457825374
Name:BLUEWATERS COUNSELING AND COACHING
Entity Type:Organization
Organization Name:BLUEWATERS COUNSELING AND COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:334-792-6736
Mailing Address - Street 1:256 HONEYSUCKLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1168
Mailing Address - Country:US
Mailing Address - Phone:334-792-6736
Mailing Address - Fax:
Practice Address - Street 1:256 HONEYSUCKLE RD STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1168
Practice Address - Country:US
Practice Address - Phone:334-792-6736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-99810OtherBLUE CROSS BLUE SHIELD