Healthcare Provider Details

I. General information

NPI: 1386193423
Provider Name (Legal Business Name): NEKIA WHITE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PATTERSON ST NE
WASHINGTON DC
20002-3334
US

IV. Provider business mailing address

2130 BROOKS DR APT 610
DISTRICT HEIGHTS MD
20747-1066
US

V. Phone/Fax

Practice location:
  • Phone: 202-354-1120
  • Fax: 202-478-0606
Mailing address:
  • Phone: 202-354-1120
  • Fax: 202-478-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50080196
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: