Provider Demographics
NPI:1336996685
Name:WHITE, CHALICE
Entity type:Individual
Prefix:
First Name:CHALICE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARLICE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12325 SHADOW CREEK PKWY APT 734
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7385
Mailing Address - Country:US
Mailing Address - Phone:504-319-4004
Mailing Address - Fax:
Practice Address - Street 1:12325 SHADOW CREEK PKWY APT 734
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7385
Practice Address - Country:US
Practice Address - Phone:504-319-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX519921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical