Provider Demographics
NPI:1629848064
Name:CARTER, WAITUS II
Entity Type:Individual
Prefix:
First Name:WAITUS
Middle Name:
Last Name:CARTER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 NW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7857
Mailing Address - Country:US
Mailing Address - Phone:754-245-4926
Mailing Address - Fax:
Practice Address - Street 1:3061 NW 72ND AVE
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7857
Practice Address - Country:US
Practice Address - Phone:754-245-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW136321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical