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NPI Code Detail

MEDICARE: MRS. KATHARINE I WAITT LCSW, LCAS

MEDICARE: MRS. KATHARINE I WAITT LCSW, LCAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1160NC
21041C0700XClinical Social WorkerC004985NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11160OTHERNCLCAS LICENSE NBR.
2C004985OTHERNCLCSW CERTIFICATION NBR.

General Provider Information

NPI Number : 1073512323
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHARINE I WAITT LCSW, LCAS
Provider Business Mailing Address
First Line : 108 N ORANGE AVE
Second Line :
City : DUNN
State : NC
Zip : 28334-3826
Country : US
Telephone Number : 910-891-7062
Fax Number : 910-892-3764
Provider Business Practice Location Address
First Line : 206 N PINE ST
Second Line :
City : ABERDEEN
State : NC
Zip : 28315-2732
Country : US
Telephone Number : 910-944-2189
Fax Number : 910-944-7443
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 01/25/2008

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