Provider Demographics
NPI:1851683478
Name:WAITE, ELIZABETH COOK (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:COOK
Last Name:WAITE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 DALLAS HWY
Mailing Address - Street 2:SUITE 402
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6458
Mailing Address - Country:US
Mailing Address - Phone:678-354-5594
Mailing Address - Fax:678-288-7945
Practice Address - Street 1:5041 DALLAS HWY
Practice Address - Street 2:SUITE 402
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6458
Practice Address - Country:US
Practice Address - Phone:678-354-5594
Practice Address - Fax:678-288-7945
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist