Provider Demographics
NPI:1245917665
Name:LACHAPPELLE-WHITE, AMANDA MARIE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:LACHAPPELLE-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 1:3600 SAN JERONIMO DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2870
Mailing Address - Country:US
Mailing Address - Phone:907-793-3200
Mailing Address - Fax:907-793-3250
Practice Address - Street 1:3600 SAN JERONIMO DR STE 210
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2870
Practice Address - Country:US
Practice Address - Phone:907-793-3200
Practice Address - Fax:907-793-3250
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AK1245917665171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health