Healthcare Provider Details

I. General information

NPI: 1043935661
Provider Name (Legal Business Name): ADRIANA VIOLA WHITE ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 HAMPTON DR
VENICE CA
90291-8633
US

IV. Provider business mailing address

204 HAMPTON DR
VENICE CA
90291-8633
US

V. Phone/Fax

Practice location:
  • Phone: 310-614-7801
  • Fax: 310-392-8402
Mailing address:
  • Phone: 310-614-7801
  • Fax: 310-392-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: