Provider Demographics
NPI:1740080589
Name:WAVES OF LIFE COUNSELING
Entity type:Organization
Organization Name:WAVES OF LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, SECRETARY, CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:YASMINE
Authorized Official - Last Name:ATWATER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-848-6731
Mailing Address - Street 1:15437 ANACAPA RD STE 29
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2458
Mailing Address - Country:US
Mailing Address - Phone:909-848-6731
Mailing Address - Fax:
Practice Address - Street 1:15437 ANACAPA RD STE 29
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2458
Practice Address - Country:US
Practice Address - Phone:909-848-6731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty