Provider Demographics
NPI:1932695129
Name:WATERS, SAMANTHA (LMHC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 TURNSTONE HAVEN PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-0826
Mailing Address - Country:US
Mailing Address - Phone:813-325-2610
Mailing Address - Fax:
Practice Address - Street 1:10022 WATER WORKS LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5301
Practice Address - Country:US
Practice Address - Phone:866-933-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH14504101YM0800X
FLMH16298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health