Provider Demographics
NPI:1518380195
Name:WHITE, NIKKI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4494 DICKSON RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32443-2401
Mailing Address - Country:US
Mailing Address - Phone:334-590-3274
Mailing Address - Fax:
Practice Address - Street 1:3035 ORCHARD RD SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3905
Practice Address - Country:US
Practice Address - Phone:334-590-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YP1600X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral