=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306617311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISA MARIE WHITE KAISER LPCMH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2024
-----------------------------------------------------
Last Update Date | 11/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 177 OLD CAMDEN RD
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19934-5500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-232-5420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 WALNUT ST
-----------------------------------------------------
City | BRIDGEVILLE
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19933-1244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-222-0981
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | PC-0011560
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------