Provider Demographics
NPI:1225048929
Name:WHITE, COLETTE (MS)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-2937
Mailing Address - Country:US
Mailing Address - Phone:806-282-3531
Mailing Address - Fax:
Practice Address - Street 1:4154 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1942
Practice Address - Country:US
Practice Address - Phone:412-295-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009239101YP2500X
TX18081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6481LCOtherBLUE CROSS BLUE SHIELD