Provider Demographics
NPI:1831956200
Name:WAITES, JAMES DAVID (LICSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:WAITES
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-4135
Mailing Address - Country:US
Mailing Address - Phone:334-580-7568
Mailing Address - Fax:
Practice Address - Street 1:2025 SHADY CREST DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5417
Practice Address - Country:US
Practice Address - Phone:205-598-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5628C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical