Provider Demographics
NPI:1447562566
Name:WHITE, PAUL D (LADAC,ACADC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:WHITE
Suffix:
Gender:M
Credentials:LADAC,ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 DELWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7492
Mailing Address - Country:US
Mailing Address - Phone:850-636-7000
Mailing Address - Fax:850-636-7071
Practice Address - Street 1:4408 DELWOOD LN
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32408-7492
Practice Address - Country:US
Practice Address - Phone:850-636-7000
Practice Address - Fax:850-636-7071
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0207101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)