Healthcare Provider Details

I. General information

NPI: 1700514130
Provider Name (Legal Business Name): CHAMPAGNE B WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 CRENSHAW BLVD
LOS ANGELES CA
90008-1821
US

IV. Provider business mailing address

3850 CRENSHAW BLVD
LOS ANGELES CA
90008-1821
US

V. Phone/Fax

Practice location:
  • Phone: 323-751-3026
  • Fax: 866-500-2156
Mailing address:
  • Phone: 323-751-3026
  • Fax: 866-500-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW122395
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW122395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: