Provider Demographics
NPI:1114163755
Name:NICOLE DAVIS WHITE, PA
Entity Type:Organization
Organization Name:NICOLE DAVIS WHITE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, JD
Authorized Official - Phone:305-933-5733
Mailing Address - Street 1:2750 NE 185TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2876
Mailing Address - Country:US
Mailing Address - Phone:305-933-5733
Mailing Address - Fax:305-933-5233
Practice Address - Street 1:2750 NE 185TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2876
Practice Address - Country:US
Practice Address - Phone:305-933-5733
Practice Address - Fax:305-933-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-04
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7520103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty