Provider Demographics
NPI:1083910509
Name:WHITE, ALICIA N (BCBA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:N
Last Name:WHITE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:D
Other - Last Name:NAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1878 E NINE MILE RD APT 1603
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5413
Mailing Address - Country:US
Mailing Address - Phone:850-341-3608
Mailing Address - Fax:
Practice Address - Street 1:2808 HAWKS LANDING BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:615-948-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246Y00000X
1-15-19917103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017740500Medicaid