Provider Demographics
NPI:1316525769
Name:WHITE, LCSW, LCSW-C, ORVON (LCSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:ORVON
Middle Name:
Last Name:WHITE, LCSW, LCSW-C
Suffix:
Gender:M
Credentials:LCSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 FAYETTEVILLE RD STE 120-152
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6297
Mailing Address - Country:US
Mailing Address - Phone:984-444-9866
Mailing Address - Fax:
Practice Address - Street 1:6409 FAYETTEVILLE RD STE 120-152
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6297
Practice Address - Country:US
Practice Address - Phone:984-444-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24668104100000X
NCC015716104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker