=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952498321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR WHITE LPC, LAC, CCS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 07/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2907 HOUSTON ST
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-4332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-730-9757
-----------------------------------------------------
Fax | 337-602-1382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 REED AVE
-----------------------------------------------------
City | EUNICE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70535-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-730-9757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | 151
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 965
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 7146
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------