Provider Demographics
NPI:1720628068
Name:WAISWILOS, CARA DARISE (MS, APC, CRC, NCC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:DARISE
Last Name:WAISWILOS
Suffix:
Gender:F
Credentials:MS, APC, CRC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 MARIETTA BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2122
Mailing Address - Country:US
Mailing Address - Phone:678-365-0071
Mailing Address - Fax:678-365-0098
Practice Address - Street 1:2120 MARIETTA BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2122
Practice Address - Country:US
Practice Address - Phone:678-365-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006616101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor