Provider Demographics
NPI:1669156345
Name:WHITE, CAROLYN FAYE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:FAYE
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 1:2111 JENKINS RD
Mailing Address - Street 2:
Mailing Address - City:ALICEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35442-4931
Mailing Address - Country:US
Mailing Address - Phone:317-440-7252
Mailing Address - Fax:205-367-1619
Practice Address - Street 1:2111 JENKINS RD
Practice Address - Street 2:
Practice Address - City:ALICEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35442-4931
Practice Address - Country:US
Practice Address - Phone:317-440-7252
Practice Address - Fax:205-367-1619
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL252Y00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency