Healthcare Provider Details

I. General information

NPI: 1982823399
Provider Name (Legal Business Name): MS. EARNESTINE BERNICE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 MANCHESTER BLVD.
INGLEWOOD CA
90305
US

IV. Provider business mailing address

3425 W MANCHESTER BLVD
INGLEWOOD CA
90305-2101
US

V. Phone/Fax

Practice location:
  • Phone: 323-778-7254
  • Fax: 800-720-1660
Mailing address:
  • Phone: 323-778-7254
  • Fax: 800-720-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: