Provider Demographics
NPI:1659040483
Name:WHITE, DANA ELIZABETH (LCAS-A)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:ELIZABETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 HARBOR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8576
Mailing Address - Country:US
Mailing Address - Phone:336-686-0236
Mailing Address - Fax:
Practice Address - Street 1:138 DUBLIN SQUARE RD STE B
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8601
Practice Address - Country:US
Practice Address - Phone:336-610-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27637101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)