Provider Demographics
NPI:1073829552
Name:WHITE, NICHOLAS (RECOVERY ASSISTANT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:RECOVERY ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 KANIS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3729
Mailing Address - Country:US
Mailing Address - Phone:501-221-1941
Mailing Address - Fax:
Practice Address - Street 1:11700 KANIS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3729
Practice Address - Country:US
Practice Address - Phone:501-221-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator