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General NPI Number Information
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NPI Number | 1891924247
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Entity Type | Individual
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Provider Name | WAYNE M EASTER LCSW, CSAC
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Gender | Male
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 5265 PROVIDENCE RD. SUITE 500
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4445
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Country | US
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Telephone | 757-354-5379
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Fax |
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Provider Business Mailing Address
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Address Line | 5265 PROVIDENCE RD STE 500
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4210
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Country | US
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Telephone | 757-467-9500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710102403
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007328
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License Number State | VA
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