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General NPI Number Information
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NPI Number | 1184846255
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Entity Type | Organization
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Legal Business Name | ELIZABETH A. WAITES, PSYCHOLOGIST P. C.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 2002 HOGBACK RD STE 15
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City | ANN ARBOR
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State | MI
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Zip | 48105-9736
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Country | US
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Telephone | 734-662-7312
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Fax |
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Provider Business Mailing Address
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Address Line | 1075 BARTON DR APT 114
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City | ANN ARBOR
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State | MI
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Zip | 48105-1260
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Country | US
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Telephone | 734-662-7312
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ELIZABETH ANGELINE WAITES
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Credential | PH.D.
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Telephone | 734-662-7312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6301001241
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License Number State | MI
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