Provider Demographics
NPI:1114526779
Name:WHITE, DEVIN ERICSON
Entity Type:Individual
Prefix:MR
First Name:DEVIN
Middle Name:ERICSON
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DC
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACSW
Mailing Address - Street 1:PO BOX 1204
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1014
Mailing Address - Country:US
Mailing Address - Phone:626-380-6840
Mailing Address - Fax:
Practice Address - Street 1:2116 ARLINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1353
Practice Address - Country:US
Practice Address - Phone:323-334-9000
Practice Address - Fax:323-334-4437
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAACSW103929101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program