Provider Demographics
NPI:1346774668
Name:WHITE, ANNIE
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:104 S CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3499
Mailing Address - Country:US
Mailing Address - Phone:601-653-0908
Mailing Address - Fax:800-507-2906
Practice Address - Street 1:104 S CANAL ST
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3499
Practice Address - Country:US
Practice Address - Phone:601-653-0908
Practice Address - Fax:800-507-2906
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW6957104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker