Provider Demographics
NPI:1073082301
Name:WHITE, VERNA JEANTTE (MASTER'S DEGREE)
Entity Type:Individual
Prefix:MS
First Name:VERNA
Middle Name:JEANTTE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MASTER'S DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 HENRY WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:SHONGALOO
Mailing Address - State:LA
Mailing Address - Zip Code:71072-2650
Mailing Address - Country:US
Mailing Address - Phone:318-268-5161
Mailing Address - Fax:
Practice Address - Street 1:608 HENRY WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:SHONGALOO
Practice Address - State:LA
Practice Address - Zip Code:71072-2650
Practice Address - Country:US
Practice Address - Phone:318-268-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)