Healthcare Provider Details

I. General information

NPI: 1639456916
Provider Name (Legal Business Name): SHERRA MCMILLAN WHITE MS, LPC, LCAS-A, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 BEASLEY DRIVE, DOCTORS PARK 6A BRODY SCHOOL OF MED, ECU-DIVISION OF INFECTIOUS DISEASE
GREENVILLE NC
27834
US

IV. Provider business mailing address

2044A CAMBRIA DR
GREENVILLE NC
27834-0089
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-3256
  • Fax:
Mailing address:
  • Phone: 336-608-9021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number00113626
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2874-A
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8607
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8607
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: