Provider Demographics
NPI:1477760999
Name:WHITE, DEBBIE (CDAC II-CA)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:CDAC II-CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 E GRAND AVE
Mailing Address - Street 2:#A
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2516
Mailing Address - Country:US
Mailing Address - Phone:805-473-7185
Mailing Address - Fax:
Practice Address - Street 1:1523 LONGBRANCH AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2508
Practice Address - Country:US
Practice Address - Phone:805-473-7085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII050100218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)