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General NPI Number Information
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NPI Number | 1366571408
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Entity Type | Individual
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Provider Name | GEORGE 'DEAN' WHITE L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 768 MOUNTAIN RANCH RD
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City | SAN ANDREAS
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State | CA
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Zip | 95249-9707
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Country | US
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Telephone | 209-754-2538
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Fax |
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Provider Business Mailing Address
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Address Line | 2338 N ALPINE RD
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City | STOCKTON
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State | CA
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Zip | 95215-9763
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Country | US
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Telephone | 209-931-5004
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 20788
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License Number State | CA
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