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NPI Code Detail

MEDICARE: DONNA K WHITE-LAND MSW, LCSW, QMHP

MEDICARE: DONNA K WHITE-LAND MSW, LCSW, QMHP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor149009615IL

General Provider Information

NPI Number : 1013287275
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA K WHITE-LAND MSW, LCSW, QMHP
Provider Business Mailing Address
First Line : 1412 US HIGHWAY 45 N
Second Line :
City : ELDORADO
State : IL
Zip : 62930-3766
Country : US
Telephone Number : 618-273-3326
Fax Number : 618-273-2808
Provider Business Practice Location Address
First Line : 1412 US HIGHWAY 45 N
Second Line :
City : ELDORADO
State : IL
Zip : 62930-3766
Country : US
Telephone Number : 618-273-3326
Fax Number : 618-273-2808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2012
Last Update Date : 01/05/2012

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Directions to “ DONNA K WHITE-LAND MSW, LCSW, QMHP” Practice Location

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