Provider Demographics
NPI:1770823619
Name:WHITE, REBECCA CELIA (M,A, LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CELIA
Last Name:WHITE
Suffix:
Gender:F
Credentials:M,A, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6043 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5411
Mailing Address - Country:US
Mailing Address - Phone:310-721-7338
Mailing Address - Fax:
Practice Address - Street 1:6043 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-5411
Practice Address - Country:US
Practice Address - Phone:310-721-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist