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General NPI Number Information
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NPI Number | 1437521663
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Entity Type | Individual
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Provider Name | IMANI WHITE BC-DMT, LPCC
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Gender | Female
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 13727 SW 152ND ST # 886
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City | MIAMI
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State | FL
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Zip | 33177-1106
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Country | US
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Telephone | 312-766-6780
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Fax | 312-261-5080
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Provider Business Mailing Address
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Address Line | PO BOX 3856
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City | NORTH FORT MYERS
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State | FL
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Zip | 33918-3856
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Country | US
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Telephone | 312-766-6780
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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 | LPCC5463
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | BCDMT1302
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License Number State | CA
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