Provider Demographics
NPI:1679865448
Name:WAITHAKA, NOREEN ROSE (CMHT, LPC)
Entity Type:Individual
Prefix:MS
First Name:NOREEN
Middle Name:ROSE
Last Name:WAITHAKA
Suffix:
Gender:F
Credentials:CMHT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N CONGRESS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39201-1902
Mailing Address - Country:US
Mailing Address - Phone:601-326-3717
Mailing Address - Fax:601-326-3754
Practice Address - Street 1:200 N CONGRESS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-1902
Practice Address - Country:US
Practice Address - Phone:601-326-3717
Practice Address - Fax:601-326-3754
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional