Provider Demographics
NPI:1700345675
Name:WAITE, TRACY (LPCC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WAITE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1691
Mailing Address - Country:US
Mailing Address - Phone:740-401-3088
Mailing Address - Fax:
Practice Address - Street 1:225 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1691
Practice Address - Country:US
Practice Address - Phone:740-401-3088
Practice Address - Fax:304-428-3719
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1200499-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health