Provider Demographics
NPI:1699110015
Name:WATERS, LASHAWN JANELL (MS)
Entity type:Individual
Prefix:
First Name:LASHAWN
Middle Name:JANELL
Last Name:WATERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CORPORATE CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-2418
Mailing Address - Country:US
Mailing Address - Phone:302-276-1494
Mailing Address - Fax:
Practice Address - Street 1:709 N BROOM ST
Practice Address - Street 2:APT 6
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3160
Practice Address - Country:US
Practice Address - Phone:610-761-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
DE0000785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250693189Medicaid