Provider Demographics
NPI:1588085971
Name:WHITE, WILLIAM J (LCPC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:WHITE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NOTTINGHAM CHASE
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2880
Mailing Address - Country:US
Mailing Address - Phone:309-212-4425
Mailing Address - Fax:
Practice Address - Street 1:300 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-1638
Practice Address - Country:US
Practice Address - Phone:815-777-2836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1800093831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical