Doctor Name: | WILLIE WHITE |
NPI Number: | 1013313303 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 620 S Laurel St Pine Bluff, AR - 716014859 |
Business Phone Number: | 8705344900 |
Business Fax Number: | 8705344906 |
Mailing Address: | 620 S Laurel St, PINE BLUFF |
State: | AR |
Postal Code: | 716014859 |
Phone Number: | 8705344900 |
Fax Number: | 8705344906 |
NPI Enumeration Date: | 11/13/2014 |
NPI Last Update Date: | 11/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |