Provider Demographics
NPI:1629244298
Name:WHITE, LADD E (CSAC AND LPC)
Entity Type:Individual
Prefix:
First Name:LADD
Middle Name:E
Last Name:WHITE
Suffix:
Gender:M
Credentials:CSAC AND LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SOUTH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-9519
Mailing Address - Country:US
Mailing Address - Phone:920-988-7160
Mailing Address - Fax:414-540-2171
Practice Address - Street 1:305 SOUTH ST APT 5
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038-9519
Practice Address - Country:US
Practice Address - Phone:920-988-7160
Practice Address - Fax:414-540-2171
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4097-125101YP2500X
WI1946-132101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional