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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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