Provider Demographics
NPI:1285326140
Name:WHITE, ELIZABETH WALTERS
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WALTERS
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 WAYNE ST S
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-1044
Mailing Address - Country:US
Mailing Address - Phone:574-286-3596
Mailing Address - Fax:
Practice Address - Street 1:238 HOOVER BLVD STE 30
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3782
Practice Address - Country:US
Practice Address - Phone:616-427-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker