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Organization
DLK1 LLC
Active
Organization
DLK1 LLC
Active
Other names
Still Waters Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
DIVYA KANNEGENTI (CEO)
(706) 610-0440
Entity
Organization
Contact information
Practice address
30 N GOULD ST STE R, SHERIDAN, WY 82801-6317
(706) 610-0440
Mailing address
30 N GOULD ST STE R, SHERIDAN, WY 82801-6317
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/17/2025
Last updated
01/17/2025
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