Provider Demographics
NPI:1942055967
Name:ANGELA B. WHITE, LCSW BACS
Entity type:Organization
Organization Name:ANGELA B. WHITE, LCSW BACS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-216-3239
Mailing Address - Street 1:9315 MIDVALE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3554
Mailing Address - Country:US
Mailing Address - Phone:318-216-3239
Mailing Address - Fax:318-368-1155
Practice Address - Street 1:7330 FERN AVE STE 204
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4973
Practice Address - Country:US
Practice Address - Phone:318-216-3239
Practice Address - Fax:318-368-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty