Provider Demographics
NPI:1710207832
Name:WHITE, CAROL (LISW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 SAN PEDRO DR NE STE 201B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6749
Mailing Address - Country:US
Mailing Address - Phone:505-260-9912
Mailing Address - Fax:505-260-9934
Practice Address - Street 1:1330 SAN PEDRO DR NE STE 201B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6749
Practice Address - Country:US
Practice Address - Phone:505-260-9912
Practice Address - Fax:505-260-9934
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-07119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health