Provider Demographics
NPI:1689152142
Name:WHITE, ALFRED LEE (MC60763530CP60050044)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:M
Credentials:MC60763530CP60050044
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 STRANDER BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2963
Mailing Address - Country:US
Mailing Address - Phone:206-412-2053
Mailing Address - Fax:
Practice Address - Street 1:631 STRANDER BLVD STE G
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2963
Practice Address - Country:US
Practice Address - Phone:206-412-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WAMC60763530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)