Provider Demographics
NPI:1801060355
Name:WAITKUS & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:WAITKUS & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WAITKUS
Authorized Official - Suffix:
Authorized Official - Credentials:ED,S, LPC, LMFT
Authorized Official - Phone:804-526-9885
Mailing Address - Street 1:3606 BOULEVARD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1341
Mailing Address - Country:US
Mailing Address - Phone:804-526-9885
Mailing Address - Fax:804-526-9884
Practice Address - Street 1:3606 BOULEVARD
Practice Address - Street 2:SUITE B
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1341
Practice Address - Country:US
Practice Address - Phone:804-526-9885
Practice Address - Fax:804-526-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000861106H00000X
VA0701002551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty