Healthcare Provider Details

I. General information

NPI: 1033545421
Provider Name (Legal Business Name): ERIN KELLY EMINGTON WHITE L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 DUPONT CIR STE 582
LOUISVILLE KY
40207-4888
US

IV. Provider business mailing address

626 IROQUOIS AVE
LOUISVILLE KY
40214-1290
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-5411
  • Fax:
Mailing address:
  • Phone: 502-594-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6630
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007459A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number256784
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: