Provider Demographics
NPI:1770936098
Name:WHITE, LETICIA HENRY (LMSW)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:HENRY
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:GAY
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPA
Mailing Address - Street 1:1102 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2464
Mailing Address - Country:US
Mailing Address - Phone:281-460-4702
Mailing Address - Fax:281-391-3240
Practice Address - Street 1:20915 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5548
Practice Address - Country:US
Practice Address - Phone:281-579-0703
Practice Address - Fax:281-398-9719
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58855104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker