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General NPI Number Information
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NPI Number | 1285225193
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Entity Type | Individual
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Provider Name | KELLY MICHELLE WHITE LCMHC
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Gender | Female
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 4607 CHARLOTTE HWY STE 18
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City | LAKE WYLIE
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State | SC
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Zip | 29710-8149
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Country | US
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Telephone | 803-630-3247
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Fax |
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Provider Business Mailing Address
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Address Line | 3022 OAKMERE RD
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City | WAXHAW
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State | NC
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Zip | 28173-6042
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Country | US
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Telephone | 704-604-7196
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A16324
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License Number State | NC
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