Provider Demographics
NPI:1174698674
Name:WHITE, CAROLINA RACHEL
Entity type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:RACHEL
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 1:1131 COMMUNITY PARKWAY
Mailing Address - Street 2:SAN BENITO COUNTY BEHAVIORAL HEALTH
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023
Mailing Address - Country:US
Mailing Address - Phone:831-636-4020
Mailing Address - Fax:831-636-4025
Practice Address - Street 1:1131 COMMUNITY PARKWAY
Practice Address - Street 2:SAN BENITO COUNTY BEHAVIORAL HEALTH
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023
Practice Address - Country:US
Practice Address - Phone:831-636-4020
Practice Address - Fax:831-636-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA87917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41957OtherUNICARE