Healthcare Provider Details

I. General information

NPI: 1558148262
Provider Name (Legal Business Name): THOMAS WHITE ASW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 J ST # 212
SACRAMENTO CA
95816-4712
US

IV. Provider business mailing address

5960 S LAND PARK DR # 703
SACRAMENTO CA
95822-3313
US

V. Phone/Fax

Practice location:
  • Phone: 916-860-1888
  • Fax:
Mailing address:
  • Phone: 916-860-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11457
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117983
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: