Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | FL |
NPI | 1467124685 |
---|---|
Provider Name | Christine Elizabeth White |
First Address | Lady Lake, FL 32159-5828 |
Second Address | Longwood, FL 32779-4983 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2021 |
Last Update Date | 06/10/2021 |