Healthcare Provider Details

I. General information

NPI: 1154824134
Provider Name (Legal Business Name): DEENA LORAINE WHITE LBSW AND IADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 BOWLING ST SW STE C
CEDAR RAPIDS IA
52404-5070
US

IV. Provider business mailing address

3491 QUAIL TRAIL CT
MARION IA
52302-9567
US

V. Phone/Fax

Practice location:
  • Phone: 319-531-3824
  • Fax: 319-531-3840
Mailing address:
  • Phone: 319-310-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11009
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007920
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: