Provider Demographics
NPI:1417026816
Name:WHITE, ANNE M (LICSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 E BEPLATE LN
Mailing Address - Street 2:
Mailing Address - City:POTLATCH
Mailing Address - State:ID
Mailing Address - Zip Code:83855-9762
Mailing Address - Country:US
Mailing Address - Phone:509-936-1633
Mailing Address - Fax:
Practice Address - Street 1:1086 E BEPLATE LN
Practice Address - Street 2:
Practice Address - City:POTLATCH
Practice Address - State:ID
Practice Address - Zip Code:83855-9762
Practice Address - Country:US
Practice Address - Phone:509-936-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00052272101YM0800X
WALW601303891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health