Provider Demographics
NPI:1659401156
Name:WHITE, STEPHEN LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5528 W.IRMA LANE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9343
Mailing Address - Country:US
Mailing Address - Phone:623-764-0156
Mailing Address - Fax:623-882-1731
Practice Address - Street 1:12600 N 113TH AVE STE C19
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1125
Practice Address - Country:US
Practice Address - Phone:623-764-0156
Practice Address - Fax:623-882-1731
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-29551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical