Healthcare Provider Details

I. General information

NPI: 1972407955
Provider Name (Legal Business Name): JONIQUE RICHELLE WAITERS ADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 N MAIN ST
LANCASTER SC
29720-2188
US

IV. Provider business mailing address

4600 MONTGOMERY RD STE 400
CINCINNATI OH
45212-2600
US

V. Phone/Fax

Practice location:
  • Phone: 803-745-7001
  • Fax: 803-745-7002
Mailing address:
  • Phone: 833-510-4357
  • Fax: 866-460-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADC-IP2809
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: