Healthcare Provider Details

I. General information

NPI: 1154016046
Provider Name (Legal Business Name): MORIAH CHERE GOMEZ WHITE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 NORTHWESTERN AVE
RACINE WI
53404-2520
US

IV. Provider business mailing address

6233 39TH AVE
KENOSHA WI
53142-7015
US

V. Phone/Fax

Practice location:
  • Phone: 262-652-2406
  • Fax:
Mailing address:
  • Phone: 262-654-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11872
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7317
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: