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General NPI Number Information
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NPI Number | 1619229317
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Entity Type | Individual
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Provider Name | CLEOTIS WHITE M.S.W., L.C.A.C.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 2646 HIGHWAY AVE STE 108
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City | HIGHLAND
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State | IN
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Zip | 46322
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Country | US
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Telephone | 219-801-1789
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Fax | 219-513-9506
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Provider Business Mailing Address
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Address Line | 2646 HIGHWAY AVE STE 108
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City | HIGHLAND
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State | IN
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Zip | 46322-1662
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Country | US
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Telephone | 219-801-1789
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Fax | 219-513-9506
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87000827A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CII-1752
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License Number State | IN
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