Provider Demographics
NPI:1689489072
Name:WHITE, LANEEN S (MS ED)
Entity type:Individual
Prefix:
First Name:LANEEN
Middle Name:S
Last Name:WHITE
Suffix:
Gender:
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 WHITE OAKS LN
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-9589
Mailing Address - Country:US
Mailing Address - Phone:757-709-5229
Mailing Address - Fax:
Practice Address - Street 1:23472 JOHN CANE RD
Practice Address - Street 2:
Practice Address - City:GREENBUSH
Practice Address - State:VA
Practice Address - Zip Code:23357-2242
Practice Address - Country:US
Practice Address - Phone:757-709-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014863251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health