Organization
BLUE WATERS FAMILY COUNSELING, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE M BERRY MSW LCSW JD (DIRECTOR)
(920) 683-3911
Entity
Organization
Contact information
Practice address
2215 WASHINGTON ST, MANITOWOC, WI 54220-4847
(920) 683-3911
(920) 683-3411
Mailing address
2215 WASHINGTON ST, MANITOWOC, WI 54220-4847
(920) 683-3911
(920) 683-3411
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42217300
—
WI
Enumeration date
08/18/2006
Last updated
02/08/2012
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