Individual
EDNA MARIE WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDAT-1 R1221770116
Contact information
Practice address
126 OHIO ST, VALLEJO, CA 94590-5049
(707) 644-5577
(707) 644-5501
Mailing address
126 OHIO ST, VALLEJO, CA 94590-5049
(707) 644-5577
(707) 644-5501
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
R1221770116
CA
Other
Enumeration date
01/09/2017
Last updated
01/09/2017
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