Provider Demographics
NPI:1285710632
Name:WHITE, KATHIE A (LCMHC)
Entity type:Individual
Prefix:
First Name:KATHIE
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FOLCUTT RD
Mailing Address - Street 2:
Mailing Address - City:KRITERY POINT
Mailing Address - State:ME
Mailing Address - Zip Code:03905
Mailing Address - Country:US
Mailing Address - Phone:207-439-0969
Mailing Address - Fax:207-438-9205
Practice Address - Street 1:35 SECOND ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-742-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30421542Medicaid