Individual
JACK WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDC-III, QMHS
Contact information
Practice address
15221 STATE ROUTE 772, PIKETON, OH 45661
(740) 493-4260
Mailing address
4431 MAPLE GROVE RD, CHILLICOTHE, OH 45601-8890
(740) 703-5507
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.161114
OH
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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