Provider Demographics
NPI:1740754167
Name:WHITE, VICKIE (LPC)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 N GALLOWAY AVE # 304-20
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4728
Mailing Address - Country:US
Mailing Address - Phone:214-809-6023
Mailing Address - Fax:
Practice Address - Street 1:3330 N GALLOWAY AVE # 304-20
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4728
Practice Address - Country:US
Practice Address - Phone:214-809-6023
Practice Address - Fax:214-809-6023
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13366518OtherSTATE LICENSE
TX2910937-01Medicaid