Provider Demographics
NPI:1477976728
Name:WATERS, ANNELIESE KIRSTEN (MSW)
Entity Type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:KIRSTEN
Last Name:WATERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19136
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32523-9136
Mailing Address - Country:US
Mailing Address - Phone:850-266-2700
Mailing Address - Fax:850-595-0180
Practice Address - Street 1:1300 N PALAFOX ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2664
Practice Address - Country:US
Practice Address - Phone:850-266-2700
Practice Address - Fax:850-595-0180
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health