Provider Demographics
NPI:1497814735
Name:WAITE, KARISS BLALOCK (MA, LPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:KARISS
Middle Name:BLALOCK
Last Name:WAITE
Suffix:
Gender:F
Credentials:MA, LPC-MHSP
Other - Prefix:MISS
Other - First Name:KARISS
Other - Middle Name:TENILLE
Other - Last Name:BLALOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,LPC-MHSP
Mailing Address - Street 1:1110 OAK CLUSTER DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-9320
Mailing Address - Country:US
Mailing Address - Phone:865-774-8835
Mailing Address - Fax:
Practice Address - Street 1:1110 OAK CLUSTER DR
Practice Address - Street 2:SUITE 4
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-9320
Practice Address - Country:US
Practice Address - Phone:865-774-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1954101YM0800X, 101YP2500X
SC4653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health