Active NPI
Crystal A Waites, LPC, LCAS,LSC
- Professional Counselor
- Fredericksburg, VA
National Provider Identifier
1669522116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0701005844
- Practice address
- 701 Kenmore Ave Ste 105
Fredericksburg, VA 22401-5792 - Phone
- (403) 225-4245
- Fax
- (866) 780-4133
- NPI assigned
- Jan 10, 2007
- Last updated
- Jul 12, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1551 | NC | |
| Professional Counselor | 101YP2500X | 6638 | NC | |
| School Counselor | 101YS0200X | 3036 | NC | |
| Professional Counselor | 101YP2500X | 0701005844 | VA | Primary |
Addresses
Primary practice location
701 Kenmore Ave Ste 105
Fredericksburg, VA 22401-5792
Mailing address
701 Kenmore Ave Ste 105
Fredericksburg, VA 22401-5792
Phone (540) 322-5424
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6103593 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701005844 | VA | MD | Professional Counselor |
| 3036 | NC | MD | School Counselor |
| 6638 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562889600000",
"number": "1669522116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 KENMORE AVE STE 105",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224015792",
"telephone_number": "540-322-5424",
"fax_number": "866-780-4133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 KENMORE AVE STE 105",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224015792",
"telephone_number": "403-225-4245",
"fax_number": "866-780-4133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAITES",
"first_name": "CRYSTAL",
"middle_name": "A",
"name_prefix": "Miss",
"credential": "LPC, LCAS,LSC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-10",
"last_updated": "2019-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "1551",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "6638",
"primary": false
},
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "NC",
"license": "3036",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701005844",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6103593",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fredericksburg, VA
- Kelly Jensen Wade, PSY.D.
- Jennifer Wadiak
- Corinnia F Wagner, AGACNP-BC
- Anne Wilson Wagstaff, MD
- Karen R. Wainright, OTR
- Hailu T Wakjera, PHARMACIST
- Wal-Mart Stores East LP (Walmart Pharmacy 10-5343)
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2520)
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1833)
- Wal-Mart Stores East LP (WalMart Pharmacy 10-4258)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.