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General NPI Number Information
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NPI Number | 1558713438
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Entity Type | Individual
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Provider Name | ANGELA WHITE LCSW BACS
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Gender | Female
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 04/21/2024
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Provider Practice Location Address
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Address Line | 7330 FERN AVE STE 204
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City | SHREVEPORT
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State | LA
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Zip | 71105-4973
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Country | US
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Telephone | 318-216-3239
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Fax | 318-368-1155
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Provider Business Mailing Address
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Address Line | 9315 MIDVALE DR
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City | SHREVEPORT
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State | LA
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Zip | 71118-3554
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Country | US
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Telephone | 318-751-0802
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Fax | 318-751-0802
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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 | 11839
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License Number State | LA
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