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NPI Code Detail

MEDICARE: MISS CRYSTAL A WAITES LPC, LCAS,LSC

MEDICARE: MISS CRYSTAL A WAITES LPC, LCAS,LSC
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) Counselor1551NC
2101YP2500XProfessional Counselor6638NC
3101YS0200XSchool Counselor3036NC
4101YP2500XProfessional Counselor0701005844VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669522116
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS CRYSTAL A WAITES LPC, LCAS,LSC
Provider Business Mailing Address
First Line : 701 KENMORE AVE STE 105
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-5792
Country : US
Telephone Number : 540-322-5424
Fax Number : 866-780-4133
Provider Business Practice Location Address
First Line : 701 KENMORE AVE STE 105
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-5792
Country : US
Telephone Number : 403-225-4245
Fax Number : 866-780-4133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 07/12/2019

Similar Medicare Providers

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1194349449 — ERIKA BOWARD WORMELEY MA, LPC
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1972127223 — KATHERINE FOUNTAIN
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1841897980 — PATRICIA CLARK LPC
Practice Location Address:
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Directions to “ MISS CRYSTAL A WAITES LPC, LCAS,LSC” Practice Location

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