Ivan White
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Citra, FL
NPI 1730614033 · NPPES record last updated Apr 24, 2017
Key facts
- NPI
- 1730614033
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- ADC-006927-2015 (FL)
- Practice address
- 15681 N US Highway 301
Citra, FL 32113-3154 - Phone
- (352) 595-5000
- Fax
- (352) 595-8431
- NPI assigned
- Apr 24, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ADC-006927-2015 | FL | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Programs of Florida, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | ADC-006927-2015 | FL | Yes |
Addresses
Primary practice location
15681 N US Highway 301
Citra, FL 32113-3154
Mailing address
6025 SE 46TH Avenue Rd
Ocala, FL 34480-7765
Other providers in Citra, FL
- Savannah Tucker
- Nicole Velez Perrone
- Ingrid Vincent
- Jared Wannenwetsch
- Concordiajo Whitaker
- Michele Correne White
- Winners Pharmacy Inc.
All providers in Citra, FL · Addiction (Substance Use Disorder) Counselor in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.