Provider Demographics
NPI:1952959520
Name:WATERS-MASON, CHARNETTA ROCHELLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CHARNETTA
Middle Name:ROCHELLE
Last Name:WATERS-MASON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CHARNETA
Other - Middle Name:ROCHELLE
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1246 28TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4216
Mailing Address - Country:US
Mailing Address - Phone:757-907-7609
Mailing Address - Fax:
Practice Address - Street 1:2120 STAPLES MILL RD STE 211
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2917
Practice Address - Country:US
Practice Address - Phone:757-907-7609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional