Healthcare Provider Details

I. General information

NPI: 1518380195
Provider Name (Legal Business Name): NIKKI WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2014
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 ORCHARD RD SW
CONYERS GA
30094-3905
US

IV. Provider business mailing address

4494 DICKSON RD
GREENWOOD FL
32443-2401
US

V. Phone/Fax

Practice location:
  • Phone: 334-590-3274
  • Fax:
Mailing address:
  • Phone: 334-590-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: