Individual
MISS CRYSTAL A WAITES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LCAS,LSC
Contact information
Practice address
701 KENMORE AVE STE 105, FREDERICKSBURG, VA 22401-5792
(403) 225-4245
(866) 780-4133
Mailing address
701 KENMORE AVE STE 105, FREDERICKSBURG, VA 22401-5792
(540) 322-5424
(866) 780-4133
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1551
NC
101YP2500X
Professional Counselor
Primary
0701005844
VA
101YP2500X
Professional Counselor
6638
NC
101YS0200X
School Counselor
3036
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6103593
—
NC
Enumeration date
01/10/2007
Last updated
07/12/2019
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