Healthcare Provider Details

I. General information

NPI: 1053509802
Provider Name (Legal Business Name): LENAE WHITE, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8222 DOUGLAS AVE STE. 390
DALLAS TX
75225-5923
US

IV. Provider business mailing address

8222 DOUGLAS AVE STE. 390
DALLAS TX
75225-5923
US

V. Phone/Fax

Practice location:
  • Phone: 214-234-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberL7601
License Number StateTX

VIII. Authorized Official

Name: CALLIE LILES
Title or Position: CLINIC DIRECTOR
Credential: LCSW
Phone: 214-234-2400