Provider Demographics
NPI:1306320627
Name:WHITE, NATHAN LLOYD (LMSW)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:LLOYD
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43249 BROOKS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5323
Mailing Address - Country:US
Mailing Address - Phone:586-248-3408
Mailing Address - Fax:
Practice Address - Street 1:18303 E 10 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4989
Practice Address - Country:US
Practice Address - Phone:313-296-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801103242104100000X
MI68011094251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker