Healthcare Provider Details

I. General information

NPI: 1891425120
Provider Name (Legal Business Name): MICHAEL JAMES WHITE LCSW, PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WOOLSEY ST
BERKELEY CA
94705-1973
US

IV. Provider business mailing address

2320 WOOLSEY ST
BERKELEY CA
94705-1973
US

V. Phone/Fax

Practice location:
  • Phone: 925-588-9613
  • Fax:
Mailing address:
  • Phone: 106-475-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number85366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: