MEDICARE: MR. VICTOR WHITE LPC, LAC, CCS

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
1	171M00000X	Case Manager/Care Coordinator	151	LA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	965	LA
3	101YP2500X	Professional Counselor	7146	LA

General Provider Information

NPI Number	:	1952498321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VICTOR WHITE LPC, LAC, CCS

Provider Business Mailing Address
First Line	:	500 REED AVE
Second Line	:
City	:	EUNICE
State	:	LA
Zip	:	70535-3238
Country	:	US
Telephone Number	:	318-730-9757
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 HOUSTON ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-4332
Country	:	US
Telephone Number	:	318-730-9757
Fax Number	:	337-602-1382

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/20/2023

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