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General NPI Number Information
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NPI Number | 1538213103
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Entity Type | Individual
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Provider Name | JEFFREY GORDON WHITE LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 8036 MOORSBRIDGE RD SUITE 2
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City | PORTAGE
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State | MI
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Zip | 49024-4419
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Country | US
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Telephone | 269-327-1438
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Fax | 269-327-6454
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Provider Business Mailing Address
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Address Line | 5121 WILLOWBEND TRL
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City | KALAMAZOO
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State | MI
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Zip | 49009-9593
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Country | US
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Telephone | 917-355-5801
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007303
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License Number State | CT
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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 | 076562
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801093325
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License Number State | MI
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