Healthcare Provider Details

I. General information

NPI: 1285938746
Provider Name (Legal Business Name): DAWN GRACE WHITE MS, LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 PROVIDENCE RD
VIRGINIA BEACH VA
23464-4128
US

IV. Provider business mailing address

2112 KIMBALL CIR
VIRGINIA BEACH VA
23455-2550
US

V. Phone/Fax

Practice location:
  • Phone: 757-347-8840
  • Fax:
Mailing address:
  • Phone: 757-233-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008920
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704009015
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: