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Organization
WATERSIDE THERAPY ASSOCIATES, P.L.L.C.
Active
Organization
WATERSIDE THERAPY ASSOCIATES, P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RITA CAROL BOYETTE LCSW (CO-OWNER)
(252) 944-6076
Entity
Organization
Contact information
Practice address
110 BALTIMORE ST, WILLIAMSTON, NC 27892-2462
(252) 944-6076
(252) 923-0111
Mailing address
110 BALTIMORE ST, WILLIAMSTON, NC 27892-2462
(252) 944-6076
(252) 923-0111
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
5036
NC
1041C0700X
Clinical Social Worker
Primary
C002961
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10894
BCBS
NC
01
—
14144
BCBS
NC
01
—
235086
MHN
NC
01
—
24392-2143
TRICARE
NC
05
—
6003548
—
NC
05
—
6102939
—
NC
Enumeration date
07/09/2006
Last updated
11/14/2011
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