Provider Demographics
NPI:1457769648
Name:WHITE, LOREN (LICSW)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD AVE S
Mailing Address - Street 2:CCB 472
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-2050
Mailing Address - Country:US
Mailing Address - Phone:205-934-1232
Mailing Address - Fax:205-975-8950
Practice Address - Street 1:908 20TH ST S
Practice Address - Street 2:472 COMMUNITY CARE BUILDING
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-2050
Practice Address - Country:US
Practice Address - Phone:205-934-1232
Practice Address - Fax:205-975-8950
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3507G104100000X
AL3944C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker