Provider Demographics
NPI:1275702565
Name:WHITE, TERESA A
Entity Type:Individual
Prefix:MR
First Name:TERESA
Middle Name:A
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 1:2290 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-9562
Mailing Address - Country:US
Mailing Address - Phone:352-787-6129
Mailing Address - Fax:352-787-4072
Practice Address - Street 1:2290 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-9562
Practice Address - Country:US
Practice Address - Phone:352-787-6129
Practice Address - Fax:352-787-4072
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker