Provider Demographics
NPI:1629360383
Name:WHITE, TONY (LCSW)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2493
Mailing Address - Country:US
Mailing Address - Phone:240-532-2399
Mailing Address - Fax:870-300-3290
Practice Address - Street 1:1206 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-2493
Practice Address - Country:US
Practice Address - Phone:240-532-2399
Practice Address - Fax:870-300-3290
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2200-C1041C0700X
DCLC500785911041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical