Provider Demographics
NPI:1063535532
Name:WHITE, TERESA GAIL (MS LADC, LPC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:GAIL
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS LADC, LPC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:GAIL
Other - Last Name:CALANDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LADC, LPC
Mailing Address - Street 1:1219 K ST.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-9999
Mailing Address - Country:US
Mailing Address - Phone:580-798-4523
Mailing Address - Fax:580-319-4523
Practice Address - Street 1:1219 K ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-9999
Practice Address - Country:US
Practice Address - Phone:580-798-4523
Practice Address - Fax:580-319-4523
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OK5115101YP2500X
OK957101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)