# WATERFORD ACADEMY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205256211
- **Authorized official:** MR. MARK PETTY (OWNER)
- **Authorized official phone:** (972) 365-5318

## Contact information

- **Practice address:** 1033 LONG PRAIRIE RD STE 3, FLOWER MOUND, TX 75022-4230
- **Practice address phone:** (972) 355-9083
- **Mailing address:** 1033 LONG PRAIRIE RD STE 3, FLOWER MOUND, TX 75022-4230
- **Mailing address phone:** (972) 355-9083

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2014
- **Last updated:** 04/17/2014