Provider Demographics
NPI:1043646508
Name:WHITE, LAURA VIANNA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:VIANNA
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-1114 HALELOKE PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3101
Mailing Address - Country:US
Mailing Address - Phone:808-754-5792
Mailing Address - Fax:
Practice Address - Street 1:45-1114 HALELOKE PL
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3101
Practice Address - Country:US
Practice Address - Phone:808-754-5792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor