Provider Demographics
NPI:1184136368
Name:WHITE-PERRY, TAWANA MICHELLE
Entity type:Individual
Prefix:
First Name:TAWANA
Middle Name:MICHELLE
Last Name:WHITE-PERRY
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 1:106 E KINGS HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3426
Mailing Address - Country:US
Mailing Address - Phone:318-606-5335
Mailing Address - Fax:318-606-5671
Practice Address - Street 1:106 E KINGS HWY STE 101
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-606-5335
Practice Address - Fax:315-606-5671
Is Sole Proprietor?:No
Enumeration Date:2017-10-28
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker