Provider Demographics
NPI:1437521663
Name:WHITE, IMANI (BC-DMT, LPCC)
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:BC-DMT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3856
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33918-3856
Mailing Address - Country:US
Mailing Address - Phone:312-766-6780
Mailing Address - Fax:
Practice Address - Street 1:13727 SW 152ND ST # 886
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1106
Practice Address - Country:US
Practice Address - Phone:312-766-6780
Practice Address - Fax:312-261-5080
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC5463101YP2500X
CABCDMT1302225600000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner