Individual
ANGELA WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHCA
Contact information
Practice address
4150 ILLINOIS RD, FORT WAYNE, IN 46804-1208
(260) 702-3759
Mailing address
2026 ARDMORE AVE APT 109, FORT WAYNE, IN 46802-4863
(949) 525-8414
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
88001696A
IN
Other
Enumeration date
03/18/2024
Last updated
03/20/2024
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