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General NPI Number Information
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NPI Number | 1063984037
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Entity Type | Individual
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Provider Name | GRACE WHITE MA, NCC, LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/01/2019
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 659 W RANDOLPH ST APT 1808
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City | CHICAGO
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State | IL
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Zip | 60661-2252
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Country | US
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Telephone | 615-945-5882
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Fax |
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Provider Business Mailing Address
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Address Line | 659 W RANDOLPH ST APT 1808
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City | CHICAGO
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State | IL
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Zip | 60661-2252
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Country | US
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Telephone | 615-945-5882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180013594
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License Number State | IL
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