Provider Demographics
NPI:1891924247
Name:EASTER, WAYNE M (LCSW, CSAC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:M
Last Name:EASTER
Suffix:
Gender:M
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 PROVIDENCE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4210
Mailing Address - Country:US
Mailing Address - Phone:757-467-9500
Mailing Address - Fax:
Practice Address - Street 1:5265 PROVIDENCE RD.
Practice Address - Street 2:SUITE 500
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4445
Practice Address - Country:US
Practice Address - Phone:757-354-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102403101YA0400X
VA09040073281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)