Provider Demographics
NPI:1073512323
Name:WAITT, KATHARINE I (LCSW, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:I
Last Name:WAITT
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-3826
Mailing Address - Country:US
Mailing Address - Phone:910-891-7062
Mailing Address - Fax:910-892-3764
Practice Address - Street 1:206 N PINE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2732
Practice Address - Country:US
Practice Address - Phone:910-944-2189
Practice Address - Fax:910-944-7443
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1160101YA0400X
NCC0049851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1160OtherLCAS LICENSE NBR.
NCC004985OtherLCSW CERTIFICATION NBR.
MEME0584Medicare ID - Type Unspecified