Provider Demographics
NPI:1164200937
Name:WHITE, KENIA (LMSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7918
Mailing Address - Country:US
Mailing Address - Phone:423-531-3398
Mailing Address - Fax:
Practice Address - Street 1:9219 LEE HWY STE 103
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4440
Practice Address - Country:US
Practice Address - Phone:423-531-3398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000013027104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker