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General NPI Number Information
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NPI Number | 1164200937
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Entity Type | Individual
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Provider Name | KENIA WHITE LMSW, LCSWA
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Gender | Female
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 9219 LEE HWY STE 103
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City | OOLTEWAH
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State | TN
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Zip | 37363-4440
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Country | US
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Telephone | 423-531-3398
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 EXECUTIVE DR
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City | HIXSON
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State | TN
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Zip | 37343-7918
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Country | US
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Telephone | 423-531-3398
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW0000013027
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License Number State | TN
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