| Krystina M. White, Licsw, Llc | |
|
11 Hughes Rd Ste 202 Madison AL 35758-3037 | |
| (256) 694-3856 | |
| Not Available |
| Full Name | Krystina M. White, Licsw, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11 Hughes Rd Ste 202, Madison, Alabama |
| Authorized Official Name and Position | Krystina White (OWNER) |
| Authorized Official Contact | 2569751023 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Krystina M. White, Licsw, Llc 23884 Wales St Elkmont AL 35620-3857 Ph: (256) 975-1023 | Krystina M. White, Licsw, Llc 11 Hughes Rd Ste 202 Madison AL 35758-3037 Ph: (256) 694-3856 |
| NPI Number | 1659089365 |
|---|---|
| Provider Enumeration Date | 11/10/2022 |
| Last Update Date | 09/25/2024 |
| Certification Date | 09/25/2024 |
| Medicare PECOS PAC ID | 0446623490 |
|---|---|
| Medicare Enrollment ID | O20230222002480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659089365 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Krystina M White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003287764 PECOS PAC ID: 2163773938 Enrollment ID: I20180918004380 |
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