Provider Demographics
NPI:1225386931
Name:WAITERS, LAWANA (THD, PSYD,)
Entity Type:Individual
Prefix:DR
First Name:LAWANA
Middle Name:
Last Name:WAITERS
Suffix:
Gender:F
Credentials:THD, PSYD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 31
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237-0031
Mailing Address - Country:US
Mailing Address - Phone:770-572-9317
Mailing Address - Fax:
Practice Address - Street 1:136 HIGHWAY 138
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-572-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor