Provider Demographics
NPI:1154951879
Name:WHITE, KEENA S (LPC)
Entity type:Individual
Prefix:
First Name:KEENA
Middle Name:S
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 RAHWAY AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3648
Mailing Address - Country:US
Mailing Address - Phone:732-574-0785
Mailing Address - Fax:
Practice Address - Street 1:843 RAHWAY AVE FL 2
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3648
Practice Address - Country:US
Practice Address - Phone:732-574-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00692300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health