Provider Demographics
NPI:1730632506
Name:WAITE, SELENA (LPA, LCMHC, HSP-PA)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:WAITE
Suffix:
Gender:F
Credentials:LPA, LCMHC, HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 NEBO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4231
Mailing Address - Country:US
Mailing Address - Phone:919-884-1108
Mailing Address - Fax:
Practice Address - Street 1:2310 S MIAMI BLVD STE 142
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-4900
Practice Address - Country:US
Practice Address - Phone:984-212-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11931101YP2500X, 101YM0800X
NC5371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist