Provider Demographics
NPI:1942706866
Name:WHITE, STEPHAN DARREL (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:DARREL
Last Name:WHITE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WESTRIDGE ST APT 121
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1523
Mailing Address - Country:US
Mailing Address - Phone:832-452-1993
Mailing Address - Fax:
Practice Address - Street 1:2700 WESTRIDGE ST APT 121
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1523
Practice Address - Country:US
Practice Address - Phone:832-452-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX568861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical