Provider Demographics
NPI:1154101939
Name:WAVES WELLNESS & COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:WAVES WELLNESS & COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-550-1139
Mailing Address - Street 1:34 WOODLAWN DR APT 4
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3533
Mailing Address - Country:US
Mailing Address - Phone:630-550-1139
Mailing Address - Fax:
Practice Address - Street 1:34 WOODLAWN DR APT 4
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3533
Practice Address - Country:US
Practice Address - Phone:630-550-1139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty