Individual
MICKELLE KAREN WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1360 CALISTA DRIVE, BH SOBERING CENTER, BETHEL, AK 99559-0528
(907) 543-6830
Mailing address
PO BOX 528, ATTN: BH SOBERING CENTER, BETHEL, AK 99559-0528
(907) 543-6830
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020986
—
AK
Enumeration date
06/11/2014
Last updated
06/11/2014
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