Provider Demographics
NPI:1831227636
Name:WHITE, ADA MARLENE (SERVICE COORDINATOR)
Entity type:Individual
Prefix:MRS
First Name:ADA
Middle Name:MARLENE
Last Name:WHITE
Suffix:
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 DANIELS FORK RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-8049
Mailing Address - Country:US
Mailing Address - Phone:606-928-5528
Mailing Address - Fax:
Practice Address - Street 1:5235 DANIELS FORK RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-8049
Practice Address - Country:US
Practice Address - Phone:606-928-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFS01866171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator