Provider Demographics
NPI:1427091313
Name:WHITE, SANDRA (LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 N 3RD ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-7033
Mailing Address - Country:US
Mailing Address - Phone:325-675-5990
Mailing Address - Fax:325-673-9414
Practice Address - Street 1:3301 N 3RD ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-7033
Practice Address - Country:US
Practice Address - Phone:325-675-5990
Practice Address - Fax:325-673-9414
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11870101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095753201Medicaid
TX095753201Medicaid