Provider Demographics
NPI:1558713438
Name:WHITE, ANGELA (LCSW BACS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 MIDVALE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3554
Mailing Address - Country:US
Mailing Address - Phone:318-751-0802
Mailing Address - Fax:318-751-0802
Practice Address - Street 1:7330 FERN AVE STE 204
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4973
Practice Address - Country:US
Practice Address - Phone:318-216-3239
Practice Address - Fax:318-368-1155
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA118391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical