Provider Demographics
NPI:1972826220
Name:WHITE, DAVID J (CADC I)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:WHITE
Suffix:
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3793 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4827
Mailing Address - Country:US
Mailing Address - Phone:503-304-7002
Mailing Address - Fax:503-304-7049
Practice Address - Street 1:3793 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4827
Practice Address - Country:US
Practice Address - Phone:503-304-7002
Practice Address - Fax:503-304-7049
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR415-051-0000101Y00000X
OR415-051-0130101Y00000X
OR415-054-0005101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor