Provider Demographics
NPI:1851962682
Name:WHITE, CASSIE LYNN (BA)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BENONI AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-0045
Mailing Address - Country:US
Mailing Address - Phone:681-404-6135
Mailing Address - Fax:
Practice Address - Street 1:701 BENONI AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-0045
Practice Address - Country:US
Practice Address - Phone:681-404-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator