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General NPI Number Information
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NPI Number | 1174076046
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Entity Type | Organization
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Legal Business Name | DAVID AND DELORES WHITE
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 4702 N LAURENT ST SUITE D
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City | VICTORIA
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State | TX
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Zip | 77904-2147
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Country | US
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Telephone | 361-572-0202
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Fax | 361-572-0300
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Provider Business Mailing Address
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Address Line | 4702 N LAURENT ST SUITE D
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City | VICTORIA
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State | TX
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Zip | 77904-2147
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Country | US
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Telephone | 361-572-0202
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Fax | 361-572-0300
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. DELORES EVENS WHITE
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Credential | M.A., LPC
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Telephone | 361-572-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 66862
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License Number State | TX
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