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NPI Code Detail

MEDICARE: MS. JACQUELINE DANIELLE WHITE LCDC

MEDICARE: MS. JACQUELINE DANIELLE WHITE LCDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor16617TX

General Provider Information

NPI Number : 1497587158
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE DANIELLE WHITE LCDC
Provider Business Mailing Address
First Line : PO BOX 211193
Second Line :
City : BEDFORD
State : TX
Zip : 76095-8193
Country : US
Telephone Number : 214-629-0529
Fax Number :
Provider Business Practice Location Address
First Line : 511 E JOHN CARPENTER FWY STE 500
Second Line :
City : IRVING
State : TX
Zip : 75062-8138
Country : US
Telephone Number : 682-351-8907
Fax Number : 214-594-9842
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2024
Last Update Date : 01/11/2026

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