Provider Demographics
NPI:1700211901
Name:WAIT, LINDA C (BA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:WAIT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 BURLINGTON AVE N
Mailing Address - Street 2:APT. 11
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8548
Mailing Address - Country:US
Mailing Address - Phone:727-328-4007
Mailing Address - Fax:727-822-6240
Practice Address - Street 1:3461 BURLINGTON AVE N
Practice Address - Street 2:APT. 11
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8548
Practice Address - Country:US
Practice Address - Phone:727-328-4007
Practice Address - Fax:727-822-6240
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health