Provider Demographics
NPI:1568628303
Name:WHITE, DARLENE SANDRA (LAC LICENSED ADDICTI)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:SANDRA
Last Name:WHITE
Suffix:
Gender:F
Credentials:LAC LICENSED ADDICTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 8TH AVE NE
Mailing Address - Street 2:HAZEN MEMORIAL HOSPITAL ASSOCIATION
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545
Mailing Address - Country:US
Mailing Address - Phone:701-748-2225
Mailing Address - Fax:701-748-3889
Practice Address - Street 1:510 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545
Practice Address - Country:US
Practice Address - Phone:701-748-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1007101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)