Individual
LISA WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4385 W STOLLEY PARK RD, ALDA, NE 68810-9798
(308) 383-1622
Mailing address
4385 W STOLLEY PARK RD, ALDA, NE 68810-9798
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
P-1375
NE
101YM0800X
Mental Health Counselor
Primary
10970
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13879032
CAQH
NE
Enumeration date
08/22/2016
Last updated
08/22/2016
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