Provider Demographics
NPI:1568087146
Name:TRANQUIL WATERS COUNSELING (LCSW) PLLC
Entity Type:Organization
Organization Name:TRANQUIL WATERS COUNSELING (LCSW) PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:716-449-0494
Mailing Address - Street 1:6252 TUPELO LN
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9472
Mailing Address - Country:US
Mailing Address - Phone:716-713-3532
Mailing Address - Fax:
Practice Address - Street 1:4535 SOUTHWESTERN BLVD STE 706A
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1870
Practice Address - Country:US
Practice Address - Phone:716-449-0494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty