Provider Demographics
NPI:1205955838
Name:WATERS, KAREN A (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:A
Last Name:WATERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 VILLAGE GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1962
Mailing Address - Country:US
Mailing Address - Phone:804-454-0874
Mailing Address - Fax:
Practice Address - Street 1:7301 FOREST AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3792
Practice Address - Country:US
Practice Address - Phone:804-285-4121
Practice Address - Fax:804-285-4123
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical