Provider Demographics
NPI:1972525137
Name:WHITE, DEBRA JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JOAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 MCFARLAND RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5713
Mailing Address - Country:US
Mailing Address - Phone:707-823-2510
Mailing Address - Fax:
Practice Address - Street 1:625 CHERRY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4202
Practice Address - Country:US
Practice Address - Phone:707-573-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8422103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL84220Medicare ID - Type UnspecifiedPROVIDER NUMBER