Provider Demographics
NPI:1639676208
Name:WATERS, JOHN MITCHELL (MA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MITCHELL
Last Name:WATERS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4511
Mailing Address - Country:US
Mailing Address - Phone:142-344-3560
Mailing Address - Fax:
Practice Address - Street 1:7209 HAMILTON ACRES CIR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8623
Practice Address - Country:US
Practice Address - Phone:423-499-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional