Provider Demographics
NPI:1831254978
Name:WATERS, CAROL A (MA, LPC, CAADC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:WATERS
Suffix:
Gender:F
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 CORVALLIS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-7935
Mailing Address - Country:US
Mailing Address - Phone:989-289-5632
Mailing Address - Fax:
Practice Address - Street 1:122 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-1024
Practice Address - Country:US
Practice Address - Phone:989-388-4185
Practice Address - Fax:989-388-4187
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI6401010542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)