Provider Demographics
NPI:1588792154
Name:WHITE, PAMELA ELAINE (MA, LPC, BCIA-C)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ELAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LPC, BCIA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E INTERSTATE 30 # 247
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5408
Mailing Address - Country:US
Mailing Address - Phone:214-476-0306
Mailing Address - Fax:972-722-9407
Practice Address - Street 1:507 E BOYDSTUN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3956
Practice Address - Country:US
Practice Address - Phone:214-476-0306
Practice Address - Fax:972-722-9407
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health