Provider Demographics
NPI:1720698673
Name:HEALING WATER CONNECTIONS
Entity Type:Organization
Organization Name:HEALING WATER CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:ROXANA
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:623-414-9488
Mailing Address - Street 1:1038 E COLTER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2622
Mailing Address - Country:US
Mailing Address - Phone:623-414-9488
Mailing Address - Fax:
Practice Address - Street 1:1038 E COLTER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2622
Practice Address - Country:US
Practice Address - Phone:623-414-9488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty