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General NPI Number Information
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NPI Number | 1801060355
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Entity Type | Organization
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Legal Business Name | WAITKUS & ASSOCIATES, P.C.
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 3606 BOULEVARD SUITE B
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-1341
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Country | US
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Telephone | 804-526-9885
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Fax | 804-526-9884
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Provider Business Mailing Address
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Address Line | 3606 BOULEVARD SUITE B
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-1341
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Country | US
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Telephone | 804-526-9885
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Fax | 804-526-9884
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Authorized Official
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Title or Position | DIRECTOR
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Name | PAMELA ANN WAITKUS
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Credential | ED.,S., LPC, LMFT
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Telephone | 804-526-9885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717000861
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701002551
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License Number State | VA
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