MEDICARE: MRS. NICOLE CARLTON WHITE LMHC

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	101YM0800X	Mental Health Counselor	MH13891	FL

General Provider Information

NPI Number	:	1710700307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE CARLTON WHITE LMHC

Provider Business Mailing Address
First Line	:	149 SE CAROB GLN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-1809
Country	:	US
Telephone Number	:	352-284-0526
Fax Number	:

Provider Business Practice Location Address
First Line	:	484 N MARION AVE
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-2802
Country	:	US
Telephone Number	:	352-284-0526
Fax Number	:

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

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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