| Open Water Wellness Pllc | |
|
410 New Bridge St Ste 9b Jacksonville NC 28540-4759 | |
| (910) 939-1127 | |
| (855) 978-1077 |
| Full Name | Open Water Wellness Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 410 New Bridge St Ste 9b, Jacksonville, North Carolina |
| Authorized Official Name and Position | Karen Kaminski Esala (MENTAL HEALTH CLINICIAN/OWNER) |
| Authorized Official Contact | 9109391127 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Open Water Wellness Pllc 722 Cedar Point Blvd # 186 Cedar Point NC 28584-8012 Ph: () - | Open Water Wellness Pllc 410 New Bridge St Ste 9b Jacksonville NC 28540-4759 Ph: (910) 939-1127 |
| NPI Number | 1437834942 |
|---|---|
| Provider Enumeration Date | 06/21/2023 |
| Last Update Date | 09/19/2023 |
| Certification Date | 09/19/2023 |
| Medicare PECOS PAC ID | 0941664114 |
|---|---|
| Medicare Enrollment ID | O20230907000967 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437834942 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Karen Kaminski Esala |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407409915 PECOS PAC ID: 3678937844 Enrollment ID: I20230907001619 |
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