Individual
KELLY J WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1503 SANTA ROSA RD, SUITE 211, RICHMOND, VA 23229-5105
(804) 289-9100
Mailing address
1503 SANTA ROSA RD, SUITE 211, RICHMOND, VA 23229-5105
(804) 289-9100
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904005930
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
07/13/2010
Last updated
08/14/2012
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