Provider Demographics
NPI:1720748718
Name:WAVES CLINICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:WAVES CLINICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISSETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-432-8727
Mailing Address - Street 1:8389 REAGAN DR
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-7149
Mailing Address - Country:US
Mailing Address - Phone:804-432-8727
Mailing Address - Fax:
Practice Address - Street 1:8389 REAGAN DR
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-7149
Practice Address - Country:US
Practice Address - Phone:804-432-8727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty