Provider Demographics
NPI:1710459789
Name:WHITE, DYAMON (LPCC, LCPC)
Entity type:Individual
Prefix:
First Name:DYAMON
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 ORION AVE
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-5116
Mailing Address - Country:US
Mailing Address - Phone:708-252-3515
Mailing Address - Fax:
Practice Address - Street 1:2020 MILVIA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2685
Practice Address - Country:US
Practice Address - Phone:708-252-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-01
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13009101YP2500X
IL180.016297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional