Provider Demographics
NPI:1851678411
Name:WHITE, LOIS M (MBA)
Entity Type:Individual
Prefix:MISS
First Name:LOIS
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 PINES RD STE H
Mailing Address - Street 2:N/A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-7301
Mailing Address - Country:US
Mailing Address - Phone:318-635-1668
Mailing Address - Fax:318-635-1668
Practice Address - Street 1:3937 PINES RD.
Practice Address - Street 2:SUITE H
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-7301
Practice Address - Country:US
Practice Address - Phone:318-635-1668
Practice Address - Fax:318-635-1668
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASTATE DOES NOT LICEN101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral