Provider Demographics
NPI:1699981761
Name:WHITE, PRISCILLA NANCY (LMHC)
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:NANCY
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARKTON RD # 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1717
Mailing Address - Country:US
Mailing Address - Phone:617-620-5516
Mailing Address - Fax:
Practice Address - Street 1:55 ROBINWOOD AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2157
Practice Address - Country:US
Practice Address - Phone:617-390-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health