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NPI Code Detail

MEDICARE: MS. HOLLY AYN WHITE

MEDICARE: MS. HOLLY AYN WHITE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1053432781
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. HOLLY AYN WHITE
Provider Business Mailing Address
First Line : 3941 PAMELA LN
Second Line :
City : STOCKTON
State : CA
Zip : 95206-6406
Country : US
Telephone Number : 206-467-3818
Fax Number :
Provider Business Practice Location Address
First Line : 3601 PACIFIC AVE
Second Line :
City : STOCKTON
State : CA
Zip : 95211-0110
Country : US
Telephone Number : 209-946-2132
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 07/08/2007

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