Healthcare Provider Details

I. General information

NPI: 1205264256
Provider Name (Legal Business Name): LENAE WHITE, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PARKER RD
CARROLLTON TX
75010-4711
US

IV. Provider business mailing address

5445 LA SIERRA DR SUITE 203
DALLAS TX
75231-4139
US

V. Phone/Fax

Practice location:
  • Phone: 972-755-3037
  • Fax: 972-755-3047
Mailing address:
  • Phone: 972-755-3037
  • Fax: 972-755-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberL7601
License Number StateTX

VIII. Authorized Official

Name: DR. TRACI LENAE WHITE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 469-471-6556