Provider Demographics
NPI:1013560374
Name:WHITE, MINDY A (MS)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MULBERRY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1233
Mailing Address - Country:US
Mailing Address - Phone:570-955-6479
Mailing Address - Fax:570-955-5528
Practice Address - Street 1:300 MULBERRY ST STE 201
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1233
Practice Address - Country:US
Practice Address - Phone:570-955-6479
Practice Address - Fax:570-955-5528
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional