Provider Demographics
NPI:1437803822
Name:WHITE, KAREN MICHELE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MICHELE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5376 CLIMBING ROCK TRL
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-8468
Mailing Address - Country:US
Mailing Address - Phone:928-533-3424
Mailing Address - Fax:
Practice Address - Street 1:3003 CENTERPOINTE EAST DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8492
Practice Address - Country:US
Practice Address - Phone:928-707-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19486104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker