Healthcare Provider Details

I. General information

NPI: 1679173256
Provider Name (Legal Business Name): BRIANNA NICOLE WHITE LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VANTAGE WAY STE E130
NASHVILLE TN
37228-1591
US

IV. Provider business mailing address

4016 UTAH AVE UNIT D
NASHVILLE TN
37209-4837
US

V. Phone/Fax

Practice location:
  • Phone: 615-988-4763
  • Fax:
Mailing address:
  • Phone: 865-216-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5013
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: