Doctor Name: | MS. CARRIE JEAN WHITE |
NPI Number: | 1245428176 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | W0501011526 |
Business Practice Address: | 991 Parallel Dr Suite B Lakeport, CA - 954535720 |
Business Phone Number: | 7072638162 |
Business Fax Number: | 7072639336 |
Mailing Address: | 991 Parallel Dr, Suite B LAKEPORT |
State: | CA |
Postal Code: | 954535720 |
Phone Number: | 7072638162 |
Fax Number: | 7072639336 |
NPI Enumeration Date: | 10/04/2007 |
NPI Last Update Date: | 09/26/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | W0501011526 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |