| Organization Name: | BLUE WATER SERENITY COUNSELING PLLC |
| NPI Number: | 1023415072 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALEXIS JOHNSON (OWNER AND SOLE PROPRIETOR) |
| Mailing Address: | 5429 Shorewood Dr Fort Gratiot |
| State: | MI US |
| Postal Code: | 480593138 |
| Phone Number: | 8103571725 |
| Fax Number: | 8108244865 |
| NPI Enumeration Date: | 11/19/2014 |
| NPI Last Update Date: | 12/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |