Most Relevant Information
Provider Data
| NPI Number: | 1003211319 |
| Provider Name: | JACQUELYN WHITE |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 102856 |
Most Important Dates
| Enumeration Date: | 10/29/2014 |
| Last Updated: | 05/08/2019 |
Provider Practice Location
720 WOOD ST
EUREKA
CA
955014413
Practice Location Phone/Fax
| Phone: | 7072682990 |
| Fax: |
Provider Mailing Location
3960 WALNUT DR
EUREKA
CA
955038938
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |