Provider Demographics
NPI:1033290747
Name:WHITE, KATHLEEN (LCMHC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 N MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3252
Mailing Address - Country:US
Mailing Address - Phone:802-772-7787
Mailing Address - Fax:
Practice Address - Street 1:65 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3252
Practice Address - Country:US
Practice Address - Phone:802-772-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007271Medicaid
VT00029296OtherBCBS