Provider Demographics
NPI:1346817103
Name:WAYMIRE, KEVIN ALEXANDER (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALEXANDER
Last Name:WAYMIRE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E LITTLE CREEK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4137
Mailing Address - Country:US
Mailing Address - Phone:757-587-4744
Mailing Address - Fax:
Practice Address - Street 1:1500 E LITTLE CREEK RD
Practice Address - Street 2:STE 205
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4137
Practice Address - Country:US
Practice Address - Phone:757-587-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty