Provider Demographics
NPI:1942631635
Name:HEALING WATERS COUNSELING, LLC
Entity Type:Organization
Organization Name:HEALING WATERS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:423-698-5090
Mailing Address - Street 1:4320 RINGGOLD RD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2712
Mailing Address - Country:US
Mailing Address - Phone:423-698-5090
Mailing Address - Fax:423-698-5090
Practice Address - Street 1:4320 RINGGOLD RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-2712
Practice Address - Country:US
Practice Address - Phone:423-698-5090
Practice Address - Fax:423-698-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN048009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty