Provider Demographics
NPI:1184846255
Name:ELIZABETH A. WAITES, PSYCHOLOGIST P. C.
Entity Type:Organization
Organization Name:ELIZABETH A. WAITES, PSYCHOLOGIST P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANGELINE
Authorized Official - Last Name:WAITES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-662-7312
Mailing Address - Street 1:1075 BARTON DR APT 114
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1260
Mailing Address - Country:US
Mailing Address - Phone:734-662-7312
Mailing Address - Fax:
Practice Address - Street 1:2002 HOGBACK RD STE 15
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9736
Practice Address - Country:US
Practice Address - Phone:734-662-7312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001241261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H14551Medicare PIN