Provider Demographics
NPI:1548894579
Name:WHITE, RICHARD PATRICK (LMHC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:PATRICK
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770520
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34777-0520
Mailing Address - Country:US
Mailing Address - Phone:407-968-8055
Mailing Address - Fax:
Practice Address - Street 1:310 S DILLARD ST STE 170
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3500
Practice Address - Country:US
Practice Address - Phone:407-968-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health