Provider Demographics
NPI:1629037593
Name:WAIDE, JOHN (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WAIDE
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 21ST AVE S
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4930
Mailing Address - Country:US
Mailing Address - Phone:615-400-5911
Mailing Address - Fax:
Practice Address - Street 1:2323 21ST AVE S
Practice Address - Street 2:SUITE 401
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4930
Practice Address - Country:US
Practice Address - Phone:615-400-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical