Provider Demographics
NPI:1598023244
Name:WHITE, VIRGINIA KAY (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:KAY
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1104
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-1104
Mailing Address - Country:US
Mailing Address - Phone:808-333-2449
Mailing Address - Fax:
Practice Address - Street 1:1266 KAMEHAMEHA AVE
Practice Address - Street 2:STE 101
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4677
Practice Address - Country:US
Practice Address - Phone:808-333-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
HI296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator