Provider Demographics
NPI:1982823399
Name:WHITE, EARNESTINE BERNICE
Entity Type:Individual
Prefix:MS
First Name:EARNESTINE
Middle Name:BERNICE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 W MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2101
Mailing Address - Country:US
Mailing Address - Phone:323-778-7254
Mailing Address - Fax:800-720-1660
Practice Address - Street 1:3425 MANCHESTER BLVD.
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305
Practice Address - Country:US
Practice Address - Phone:323-778-7254
Practice Address - Fax:800-720-1660
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)