Provider Demographics
NPI:1043730187
Name:WHITE, EVA YVONNE
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:YVONNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:YVONNE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24301 BRAZOS TOWN CROSSIN
Mailing Address - Street 2:SUITE 500 PMB1025
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-1784
Mailing Address - Country:US
Mailing Address - Phone:281-891-3515
Mailing Address - Fax:
Practice Address - Street 1:9211 RAPPAHANOOK LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-1784
Practice Address - Country:US
Practice Address - Phone:281-342-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty