Provider Demographics
NPI:1851849798
Name:WATERS, CAITLIN (LLMSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 BEACONSFIELD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-2700
Mailing Address - Country:US
Mailing Address - Phone:810-237-0799
Mailing Address - Fax:517-676-5460
Practice Address - Street 1:585 JEWETT RD
Practice Address - Street 2:BOX 289
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-8729
Practice Address - Country:US
Practice Address - Phone:517-676-5405
Practice Address - Fax:517-676-5460
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health