Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 9157 | TX |
NPI | 1003057258 |
---|---|
Provider Name | Mr. James Richard White |
First Address | Dallas, TX 75225-5923 |
Second Address | Dallas, TX 75225-5923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2009 |
Last Update Date | 18/03/2009 |