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General NPI Number Information
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NPI Number | 1861807323
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Entity Type | Individual
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Provider Name | STACY WHITE LAC
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Gender | Female
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 3820 N TOBEN ST
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City | WICHITA
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State | KS
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Zip | 67226-2903
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Country | US
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Telephone | 316-634-3954
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Fax | 316-634-3956
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Provider Business Mailing Address
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Address Line | 130 E 5TH ST PO BOX 711
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City | NEWTON
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State | KS
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Zip | 67114-2206
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Country | US
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Telephone | 316-283-6743
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Fax | 316-283-6830
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 407
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License Number State | KS
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