Provider Demographics
NPI:1497587158
Name:WHITE, JACQUELINE DANIELLE (LCDC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:DANIELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211193
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76095-8193
Mailing Address - Country:US
Mailing Address - Phone:214-629-0529
Mailing Address - Fax:
Practice Address - Street 1:511 E JOHN CARPENTER FWY STE 500
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-8138
Practice Address - Country:US
Practice Address - Phone:682-351-8907
Practice Address - Fax:214-594-9842
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16617101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)