Provider Demographics
NPI:1356225601
Name:WHITE, SOPHIA RAE
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:RAE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 E TELEGRAPH ROAD
Mailing Address - Street 2:SUITE #A, #M
Mailing Address - City:SANTA FE SPRING
Mailing Address - State:CA
Mailing Address - Zip Code:90670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11721 E TELEGRAPH ROAD
Practice Address - Street 2:SUITE #A, #M
Practice Address - City:SANTA FE SPRING
Practice Address - State:CA
Practice Address - Zip Code:90670
Practice Address - Country:US
Practice Address - Phone:562-949-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist