Provider Demographics
NPI:1902114242
Name:WHITE, ANN DERR (LMFT CRC)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:DERR
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMFT CRC
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:D
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT CRC
Mailing Address - Street 1:6700 S. FLORIDA AVENUE, SUITE 29
Mailing Address - Street 2:HULL AND ASSOCIATES, P.A.
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-644-8241
Mailing Address - Fax:863-644-9025
Practice Address - Street 1:6700 S FLORIDA AVE
Practice Address - Street 2:SUITE 29
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3327
Practice Address - Country:US
Practice Address - Phone:863-644-8241
Practice Address - Fax:863-644-9025
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist