Provider Demographics
NPI:1376354654
Name:PEACEFUL WAVES COUNSELING LLC
Entity type:Organization
Organization Name:PEACEFUL WAVES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NINI
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA, LCSW
Authorized Official - Phone:586-530-0735
Mailing Address - Street 1:1027 W RUDISILL BLVD # 207
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-2160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1027 W RUDISILL BLVD # 207
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-2160
Practice Address - Country:US
Practice Address - Phone:260-225-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty