Healthcare Provider Details

I. General information

NPI: 1811891682
Provider Name (Legal Business Name): DIAMOND ARMANI WAITES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15356 9TH AVE
PHOENIX IL
60426-2517
US

IV. Provider business mailing address

15356 9TH AVE
PHOENIX IL
60426-2517
US

V. Phone/Fax

Practice location:
  • Phone: 708-794-6597
  • Fax:
Mailing address:
  • Phone: 708-969-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.018500
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: