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General NPI Number Information
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NPI Number | 1073916912
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Entity Type | Individual
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Provider Name | LAURA E WHITE
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Gender | Female
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 1925 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-4345
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Country | US
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Telephone | 773-599-2117
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Fax |
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Provider Business Mailing Address
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Address Line | 25400 N NORTHBRIDGE RD
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City | HAWTHORN WOODS
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State | IL
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Zip | 60047-7370
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.007124
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License Number State | IL
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