Provider Demographics
NPI:1770397192
Name:WHITE, WELLINGTON WILLIAM (MA MFT ASSOCIATE MH)
Entity type:Individual
Prefix:
First Name:WELLINGTON
Middle Name:WILLIAM
Last Name:WHITE
Suffix:
Gender:M
Credentials:MA MFT ASSOCIATE MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 138TH ST S APT 20
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-4765
Mailing Address - Country:US
Mailing Address - Phone:360-324-2183
Mailing Address - Fax:
Practice Address - Street 1:14107 PACIFIC AVE S STE B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4622
Practice Address - Country:US
Practice Address - Phone:253-691-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61584539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health