Provider Demographics
NPI:1326815374
Name:WHITE HOUSE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:WHITE HOUSE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NABILA
Authorized Official - Middle Name:SADIQUA
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-763-7144
Mailing Address - Street 1:PO BOX 7113
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0113
Mailing Address - Country:US
Mailing Address - Phone:757-262-2040
Mailing Address - Fax:757-262-2070
Practice Address - Street 1:3321 W MERCURY BLVD STE D
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3806
Practice Address - Country:US
Practice Address - Phone:757-262-2040
Practice Address - Fax:757-262-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAEINMedicaid
VAEINOtherBEHAVIORAL HEALTH SERVICES