Provider Demographics
NPI:1508000985
Name:WAITE, TRACEY LEE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LEE
Last Name:WAITE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:103 CHESAPEAKE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6391
Mailing Address - Country:US
Mailing Address - Phone:410-392-4485
Mailing Address - Fax:410-392-6381
Practice Address - Street 1:103 CHESAPEAKE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6391
Practice Address - Country:US
Practice Address - Phone:410-392-4485
Practice Address - Fax:410-392-6381
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD090981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical