Healthcare Provider Details

I. General information

NPI: 1366870933
Provider Name (Legal Business Name): VIRGINIA C. WHITE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIRGINA GLENN CROWDER

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301-A PALMETTO PARK BOULEVARD LEXINGTON COUNTY COMMUNITY MENTAL HEALTH CENTER
LEXINGTON SC
29072
US

IV. Provider business mailing address

301-A PALMETTO PARK, BOULEVARD LEXINGTON COUNTY COMMUNITY MENTAL HEALTH CENTER
LEXINGTON SC
29072
US

V. Phone/Fax

Practice location:
  • Phone: 803-359-3545
  • Fax: 803-359-2111
Mailing address:
  • Phone: 803-359-3545
  • Fax: 803-359-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number37218
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: