Healthcare Provider Details

I. General information

NPI: 1316870108
Provider Name (Legal Business Name): ANGELA M WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 461
COLONIAL HEIGHTS VA
23834-0461
US

IV. Provider business mailing address

26 W OLD ST # H
PETERSBURG VA
23803-3222
US

V. Phone/Fax

Practice location:
  • Phone: 804-681-0641
  • Fax:
Mailing address:
  • Phone: 804-689-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: