Provider Demographics
NPI:1982323705
Name:WHITE, KATHY JEAN (LAC OR NCAC I)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:JEAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LAC OR NCAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-1540
Mailing Address - Country:US
Mailing Address - Phone:605-720-8090
Mailing Address - Fax:605-720-8090
Practice Address - Street 1:1238 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1540
Practice Address - Country:US
Practice Address - Phone:605-720-8090
Practice Address - Fax:605-720-8090
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD9807996101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)