Provider Demographics
NPI:1205411063
Name:WAITES, SHAYNA (LICSW)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:WAITES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13149 MUSICMASTER DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6805
Mailing Address - Country:US
Mailing Address - Phone:919-523-4272
Mailing Address - Fax:
Practice Address - Street 1:13149 MUSICMASTER DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6805
Practice Address - Country:US
Practice Address - Phone:919-523-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC215101041C0700X
DCLC500815841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical