Healthcare Provider Details

I. General information

NPI: 1922430636
Provider Name (Legal Business Name): DAVID R WHITE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 PINE ST
NORTH MIDDLETOWN NJ
07748-5544
US

IV. Provider business mailing address

304 PINE ST
NORTH MIDDLETOWN NJ
07748-5544
US

V. Phone/Fax

Practice location:
  • Phone: 201-349-0454
  • Fax:
Mailing address:
  • Phone: 201-349-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00418400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: