Provider Demographics
NPI:1902361082
Name:PATRICIA WAFER LCSW LLC
Entity Type:Organization
Organization Name:PATRICIA WAFER LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAFER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-784-6935
Mailing Address - Street 1:753 SE MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3938
Mailing Address - Country:US
Mailing Address - Phone:541-784-6935
Mailing Address - Fax:541-229-2233
Practice Address - Street 1:753 SE MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3938
Practice Address - Country:US
Practice Address - Phone:541-784-6935
Practice Address - Fax:541-229-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)