Provider Demographics
NPI:1831279421
Name:WATERS, PATRICK J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:WATERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 WRIGHTSBORO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904
Mailing Address - Country:US
Mailing Address - Phone:706-736-8170
Mailing Address - Fax:706-736-8184
Practice Address - Street 1:1727 WRIGHTSBORO RD STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4074
Practice Address - Country:US
Practice Address - Phone:706-736-8170
Practice Address - Fax:706-736-8184
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0015011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical