Provider Demographics
NPI:1407004146
Name:WHITE, TAMMY LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2617
Mailing Address - Country:US
Mailing Address - Phone:210-535-1896
Mailing Address - Fax:
Practice Address - Street 1:4410 W CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2617
Practice Address - Country:US
Practice Address - Phone:210-535-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-07
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1391C1041C0700X
TX344731041C0700X
WALW000095501041C0700X
MD164101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical