Provider Demographics
NPI:1053087791
Name:WHITE, NAVIS DEANN (LCDCI,QMHP)
Entity Type:Individual
Prefix:
First Name:NAVIS
Middle Name:DEANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCDCI,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 BRENTWOOD STAIR RD STE 404
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-1731
Mailing Address - Country:US
Mailing Address - Phone:817-492-9383
Mailing Address - Fax:
Practice Address - Street 1:4801 BRENTWOOD STAIR RD STE 404
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-1731
Practice Address - Country:US
Practice Address - Phone:817-492-9383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55687101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)