Healthcare Provider Details

I. General information

NPI: 1366954265
Provider Name (Legal Business Name): LAKESHIA NICOLE WHITE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAKESHIA NICOLE WHITE LLMSW

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 TOWN CENTER DR STE 328
DEARBORN MI
48126-2795
US

IV. Provider business mailing address

26555 EVERGREEN RD STE 870
SOUTHFIELD MI
48076-4239
US

V. Phone/Fax

Practice location:
  • Phone: 248-430-0594
  • Fax:
Mailing address:
  • Phone: 248-430-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116939
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: