Provider Demographics
NPI:1023307600
Name:WHITE, VIVA L (PHD,MSW,LCSW,LCADC)
Entity type:Individual
Prefix:DR
First Name:VIVA
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD,MSW,LCSW,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28038
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-2482
Mailing Address - Country:US
Mailing Address - Phone:862-235-0828
Mailing Address - Fax:
Practice Address - Street 1:790 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-1047
Practice Address - Country:US
Practice Address - Phone:973-517-4488
Practice Address - Fax:973-926-3577
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00095300101YA0400X
NJ44SC054545001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)