Provider Demographics
NPI:1154824134
Name:WHITE, DEENA LORAINE (LBSW AND IADC)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:LORAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LBSW AND IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3491 QUAIL TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9567
Mailing Address - Country:US
Mailing Address - Phone:319-310-0885
Mailing Address - Fax:
Practice Address - Street 1:5005 BOWLING ST SW STE C
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5070
Practice Address - Country:US
Practice Address - Phone:319-531-3824
Practice Address - Fax:319-531-3840
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0079201041C0700X
IA11009101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical