MEDICARE: NICHOLE MICHELLE WHITE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34007511A	IN

General Provider Information

NPI Number	:	1184088304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE MICHELLE WHITE LCSW

Provider Business Mailing Address
First Line	:	7144 E VIRGINIA ST STE C
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-9125
Country	:	US
Telephone Number	:	812-479-1242
Fax Number	:	812-479-1330

Provider Business Practice Location Address
First Line	:	7144 E VIRGINIA ST STE C
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-9125
Country	:	US
Telephone Number	:	812-479-1242
Fax Number	:	812-479-1330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	05/29/2024

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