Provider Demographics
NPI:1912627118
Name:WHITE, LASKIETD HARRIET
Entity type:Individual
Prefix:MS
First Name:LASKIETD
Middle Name:HARRIET
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VICTOR COMMUNITY SUPPORT SERVICES 302 CHERRY LN
Mailing Address - Street 2:SUITE101
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95203
Mailing Address - Country:US
Mailing Address - Phone:209-647-6200
Mailing Address - Fax:
Practice Address - Street 1:VICTOR COMMUNITY SUPPORT SERVICES 302 CHERRY LN
Practice Address - Street 2:SUITE101
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95203
Practice Address - Country:US
Practice Address - Phone:209-647-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health