Provider Demographics
NPI:1679960868
Name:THOMAS M WAITE LCSW
Entity type:Organization
Organization Name:THOMAS M WAITE LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, PLLC
Authorized Official - Phone:252-335-9239
Mailing Address - Street 1:102 CASTLE CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7737
Mailing Address - Country:US
Mailing Address - Phone:252-335-9239
Mailing Address - Fax:252-335-9239
Practice Address - Street 1:102 CASTLE CT
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-7737
Practice Address - Country:US
Practice Address - Phone:252-335-9239
Practice Address - Fax:252-335-9239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003627251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health