Doctor Name: | TARA JANE WHITE |
NPI Number: | 1164515805 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | LCS17611 |
Business Practice Address: | 550 E Washington Blvd Crescent City, CA - 955318342 |
Business Phone Number: | 7074656925 |
Business Fax Number: | 7074656070 |
Mailing Address: | 670 Ninth Street, Suite 203 ARCATA |
State: | CA |
Postal Code: | 95521 |
Phone Number: | 7078268633 |
Fax Number: | 7078268638 |
NPI Enumeration Date: | 10/02/2006 |
NPI Last Update Date: | 07/12/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCS17611 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |