Basic Information
| Provider Information | |||||||||
| NPI: | 1376742189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAYNE WHITE | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 641 | ||||||||
| Address2: | |||||||||
| City: | ALTADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910030641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267919401 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4920 AVALON BLVD | ||||||||
| Address2: | BAART | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900114004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232355035 | ||||||||
| FaxNumber: | 3232352023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 02/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF58060 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.