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General NPI Number Information
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NPI Number | 1306320627
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Entity Type | Individual
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Provider Name | NATHAN LLOYD WHITE LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 18303 E 10 MILE RD STE 200
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City | ROSEVILLE
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State | MI
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Zip | 48066-4989
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Country | US
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Telephone | 313-296-1799
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Fax |
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Provider Business Mailing Address
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Address Line | 43249 BROOKS DR
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-5323
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Country | US
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Telephone | 586-248-3408
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801103242
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801109425
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License Number State | MI
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