Provider Demographics
NPI:1518276401
Name:WHITE, MARTHA PATRICIA (LMHC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:PATRICIA
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:PATRICIA
Other - Last Name:ITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64-5174 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8215
Mailing Address - Country:US
Mailing Address - Phone:808-938-2989
Mailing Address - Fax:808-887-1545
Practice Address - Street 1:64-5174 WHITE RD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8215
Practice Address - Country:US
Practice Address - Phone:808-938-2989
Practice Address - Fax:808-887-1545
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health