Individual
MS. CARLY-JAYNE WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CAP
Contact information
Practice address
1201 N 37TH AVE, HOLLYWOOD, FL 33021-5414
(954) 962-1355
Mailing address
2910 OSLO AVE, HOLLYWOOD, FL 33026-4702
(954) 868-7092
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
4680
FL
1041C0700X
Clinical Social Worker
Primary
SW9830
FL
Other
Enumeration date
08/03/2012
Last updated
08/03/2012
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