Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Jack R Waites III

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1407629777

Mr. Jack R Waites III is an Addiction (Substance Use Disorder) Counselor in Los Angeles, California. Registered with an NPI since 2023.

In the registry since
2023

Practice location Address checks out

155 Bimini Pl
Los Angeles, CA 90004-5902
Phone: (213) 388-5423
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X

Record details

NPI number1407629777
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedOctober 30, 2023
Last updated in NPPESOctober 30, 2023
Certification dateOctober 30, 2023

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