Provider Demographics
NPI:1679286975
Name:WHITE, BREYON LAMONT
Entity type:Individual
Prefix:
First Name:BREYON
Middle Name:LAMONT
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7316 MONSEY CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-8362
Mailing Address - Country:US
Mailing Address - Phone:502-299-6765
Mailing Address - Fax:
Practice Address - Street 1:7316 MONSEY CIR APT 304
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-8362
Practice Address - Country:US
Practice Address - Phone:502-299-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker