Healthcare Provider Details

I. General information

NPI: 1952212870
Provider Name (Legal Business Name): CONSTANCE A. WHITE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 WATERMAN ST
PROVIDENCE RI
02906-3919
US

IV. Provider business mailing address

62 ELMGROVE AVE
PROVIDENCE RI
02906-4135
US

V. Phone/Fax

Practice location:
  • Phone: 617-721-0856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC5788
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00351
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: