Provider Demographics
NPI:1346494606
Name:WHITE, DALE W
Entity Type:Individual
Prefix:MRS
First Name:DALE
Middle Name:W
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FORT JOHNSON ROAD
Mailing Address - Street 2:JAMES ISLAND CHARTER HIGH SCHOOL
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:843-762-2754
Mailing Address - Fax:843-762-5228
Practice Address - Street 1:1000 FORT JOHNSON ROAD
Practice Address - Street 2:JAMES ISLAND CHARTER HIGH SCHOOL
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-762-2754
Practice Address - Fax:843-762-5228
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC158476103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool