Healthcare Provider Details

I. General information

NPI: 1710479431
Provider Name (Legal Business Name): JACQUELINE NICOLE WHITE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E SAGINAW ST STE 1
LANSING MI
48912-2326
US

IV. Provider business mailing address

142 BRIGHTON LAKE RD
BRIGHTON MI
48116-1738
US

V. Phone/Fax

Practice location:
  • Phone: 517-512-0698
  • Fax:
Mailing address:
  • Phone: 517-512-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401019733
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: