Healthcare Provider Details

I. General information

NPI: 1427746965
Provider Name (Legal Business Name): AMBER WAITE LCPC, CMPC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 N MASTERS DR
ADDISON IL
60101-4117
US

IV. Provider business mailing address

343 N MASTERS DR
ADDISON IL
60101-4117
US

V. Phone/Fax

Practice location:
  • Phone: 847-461-8898
  • Fax:
Mailing address:
  • Phone: 847-461-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.015668
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.017476
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: