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General NPI Number Information
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NPI Number | 1679960868
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Entity Type | Organization
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Legal Business Name | THOMAS M WAITE LCSW
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Dates
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Enumeration Date | 04/25/2015
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Last Update Date | 04/25/2015
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Provider Practice Location Address
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Address Line | 102 CASTLE CT
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-7737
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Country | US
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Telephone | 252-335-9239
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Fax | 252-335-9239
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Provider Business Mailing Address
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Address Line | 102 CASTLE CT
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-7737
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Country | US
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Telephone | 252-335-9239
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Fax | 252-335-9239
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Authorized Official
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Title or Position | CEO
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Name | THOMAS MICHAEL WAITE
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Credential | MSW, LCSW, PLLC
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Telephone | 252-335-9239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C003627
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License Number State | NC
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