Provider Demographics
NPI:1881247120
Name:WHITE, LADONNA RENE' (MSW, ASW)
Entity type:Individual
Prefix:MS
First Name:LADONNA
Middle Name:RENE'
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15501 SAN PABLO AVE # G358
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5848
Mailing Address - Country:US
Mailing Address - Phone:510-543-7224
Mailing Address - Fax:
Practice Address - Street 1:2643 APPIAN WAY STE E
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2253
Practice Address - Country:US
Practice Address - Phone:510-545-9727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA872131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical