MEDICARE: WAITE PSYCHOLOGICAL & THERAPEUTIC SERVICES

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
1	101YP2500X	Professional Counselor
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1093378382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAITE PSYCHOLOGICAL & THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	2309 NEBO ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-4231
Country	:	US
Telephone Number	:	984-212-7373
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 S MIAMI BLVD STE 142
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-4900
Country	:	US
Telephone Number	:	984-212-7373
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST/COUNSELOR
Name	:	SELENA WAITE
Credential	:
Telephone Number	:	984-212-7373

Provider Enumeration Date	:	04/22/2019
Last Update Date	:	12/27/2024

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