Provider Demographics
NPI:1356020861
Name:TRANQUIL WATERS, LLC
Entity type:Organization
Organization Name:TRANQUIL WATERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT IN COUNSELING
Authorized Official - Prefix:
Authorized Official - First Name:JAJUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP-R
Authorized Official - Phone:434-509-8588
Mailing Address - Street 1:191 SPROUSE DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-3360
Mailing Address - Country:US
Mailing Address - Phone:434-509-8588
Mailing Address - Fax:
Practice Address - Street 1:191 SPROUSE DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-3360
Practice Address - Country:US
Practice Address - Phone:434-509-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty