Healthcare Provider Details

I. General information

NPI: 1013868405
Provider Name (Legal Business Name): OLIVIA JANE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 HARMON ST APT A
BERKELEY CA
94703-2621
US

IV. Provider business mailing address

1623 HARMON ST APT A
BERKELEY CA
94703-2621
US

V. Phone/Fax

Practice location:
  • Phone: 510-365-2638
  • Fax:
Mailing address:
  • Phone: 510-365-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: