Provider Demographics
NPI:1255912838
Name:WHITE, CHRISTINE ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 KILLARNEY CT
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-8065
Mailing Address - Country:US
Mailing Address - Phone:321-795-2752
Mailing Address - Fax:
Practice Address - Street 1:872 KILLARNEY CT
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-8065
Practice Address - Country:US
Practice Address - Phone:132-179-5275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL183181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical