Organization
DAVID AND DELORES WHITE
Active
Other names
Popcorn Plus
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DELORES EVENS WHITE M.A., LPC (DIRECTOR)
(361) 572-0202
Entity
Organization
Contact information
Practice address
4702 N LAURENT ST, SUITE D, VICTORIA, TX 77904-2147
(361) 572-0202
(361) 572-0300
Mailing address
4702 N LAURENT ST, SUITE D, VICTORIA, TX 77904-2147
(361) 572-0202
(361) 572-0300
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
66862
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305544401
—
TX
Enumeration date
07/27/2016
Last updated
07/27/2016
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