Provider Demographics
NPI:1255782397
Name:WHITE, FREDA
Entity type:Individual
Prefix:
First Name:FREDA
Middle Name:
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 1:196 PULLEN LN
Mailing Address - Street 2:
Mailing Address - City:REVA
Mailing Address - State:VA
Mailing Address - Zip Code:22735-3511
Mailing Address - Country:US
Mailing Address - Phone:540-718-1261
Mailing Address - Fax:
Practice Address - Street 1:700 SOUTHRIDGE PKWY
Practice Address - Street 2:SUITE 309
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3723
Practice Address - Country:US
Practice Address - Phone:540-825-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001932237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist