1609468172 NPI number — CALM BLUE WATERS COUNSELING, PLLC

Table of content: DR. MARY LYNN JOE MD (NPI 1063402659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609468172 NPI number — CALM BLUE WATERS COUNSELING, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALM BLUE WATERS COUNSELING, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609468172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13420 REESE BLVD W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078-7925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-689-1794
Provider Business Mailing Address Fax Number:
704-464-4782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13420 REESE BLVD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078-7925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-689-1794
Provider Business Practice Location Address Fax Number:
704-464-4782
Provider Enumeration Date:
02/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CASTONGIA
Authorized Official First Name:
AMY
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
CLINICAL MENTAL HEATH COUNSELOR
Authorized Official Telephone Number:
980-689-1794

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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