Still Waters Therapy PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C010307 Issued in NC

Legal business name

STILL WATERS THERAPY PLLC

Practice address

13480 Hwy 50/210
Suite 213
Surf City, NC 28445-8609

Phone

(910) 622-3418

NPI assigned

Jun 8, 2018

Last updated

Aug 7, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Holly Mann, LCSWNPI 1013394212

Title

Licensed Clinician Social Worker

Phone

(910) 622-3418

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Holly Mann

  • Clinical Social Worker
  • Surf City, NC
  • NPI 1013394212
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533600000000",
    "number": "1831682459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421",
            "city": "HOLLY RIDGE",
            "state": "NC",
            "postal_code": "284450421",
            "telephone_number": "910-622-3418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13480 HWY 50/210",
            "address_2": "SUITE 213",
            "city": "SURF CITY",
            "state": "NC",
            "postal_code": "284458609",
            "telephone_number": "910-622-3418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILL WATERS THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-08",
        "last_updated": "2018-08-07",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "LICENSED CLINICIAN SOCIAL WORKER",
        "authorized_official_telephone_number": "910-622-3418",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C010307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Surf City, NC
• Providers in Surf City, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.