Provider Demographics
NPI:1710700307
Name:WHITE, NICOLE CARLTON (LMHC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CARLTON
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:CARLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 SE CAROB GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1809
Mailing Address - Country:US
Mailing Address - Phone:352-284-0526
Mailing Address - Fax:
Practice Address - Street 1:484 N MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-2802
Practice Address - Country:US
Practice Address - Phone:352-284-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13891101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health