Provider Demographics
NPI:1407226400
Name:WHITE, GRACE (BC-HIS)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WHITE
Suffix:
Gender:
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10519 VAUGHN ROAD
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-7763
Mailing Address - Country:US
Mailing Address - Phone:334-603-1427
Mailing Address - Fax:
Practice Address - Street 1:10519 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:PIKE ROAD
Practice Address - State:AL
Practice Address - Zip Code:36064-2700
Practice Address - Country:US
Practice Address - Phone:334-603-1427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4169237700000X
ALLPC05542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist