Provider Demographics
NPI:1871837773
Name:WHITE, TONYA J (LCSW-BACS,SCWA,SSWS)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW-BACS,SCWA,SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 OAK HARBOR BLVD.
Mailing Address - Street 2:APT. 517
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5671
Mailing Address - Country:US
Mailing Address - Phone:504-554-6488
Mailing Address - Fax:
Practice Address - Street 1:3550 OAK HARBOR BLVD.
Practice Address - Street 2:APT. 517
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5671
Practice Address - Country:US
Practice Address - Phone:504-554-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical