Provider Demographics
NPI:1831682459
Name:STILL WATERS THERAPY PLLC
Entity type:Organization
Organization Name:STILL WATERS THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICIAN SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-622-3418
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-0421
Mailing Address - Country:US
Mailing Address - Phone:910-622-3418
Mailing Address - Fax:
Practice Address - Street 1:13480 HWY 50/210
Practice Address - Street 2:SUITE 213
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-8609
Practice Address - Country:US
Practice Address - Phone:910-622-3418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0103071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty