Provider Demographics
NPI:1043742174
Name:WHITE, GENA (CADC II)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:WHITE
Suffix:
Gender:
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14515 HAMLIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1694
Mailing Address - Country:US
Mailing Address - Phone:188-442-7368
Mailing Address - Fax:
Practice Address - Street 1:14515 HAMLIN ST STE 100
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1694
Practice Address - Country:US
Practice Address - Phone:818-442-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA050691118101YA0400X
COA050691118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)