Provider Demographics
NPI:1548551153
Name:WATERS, DAREN SR (EDD, MDIV, MS, LMFT)
Entity type:Individual
Prefix:DR
First Name:DAREN
Middle Name:
Last Name:WATERS
Suffix:SR
Gender:M
Credentials:EDD, MDIV, MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 CRESTWOOD PKWY NW STE 400
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5054
Mailing Address - Country:US
Mailing Address - Phone:678-968-5881
Mailing Address - Fax:
Practice Address - Street 1:1810 W HILL AVE
Practice Address - Street 2:SUITE A10
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5154
Practice Address - Country:US
Practice Address - Phone:229-630-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
GAMFT001189106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral