Provider Demographics
NPI:1164932927
Name:WAITE, ALLISON MARIE (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:MARIE
Last Name:WAITE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 BAYPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8509
Mailing Address - Country:US
Mailing Address - Phone:949-922-6137
Mailing Address - Fax:
Practice Address - Street 1:833 DOVER DR STE 24
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-6954
Practice Address - Country:US
Practice Address - Phone:949-922-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100610106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist