Healthcare Provider Details

I. General information

NPI: 1881750057
Provider Name (Legal Business Name): MS. VICKI RAE WHITE -DANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DOUGLAS DR STE 140
MARTINEZ CA
94553-4078
US

IV. Provider business mailing address

10 DOUGLAS DR STE 140
MARTINEZ CA
94553-4078
US

V. Phone/Fax

Practice location:
  • Phone: 252-381-5569
  • Fax: 925-313-1142
Mailing address:
  • Phone: 925-405-7138
  • Fax: 925-313-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: