Provider Demographics
NPI:1114279312
Name:WHITE, NICHOLAS WILLIAM (DA, LCSW, MLADC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:WILLIAM
Last Name:WHITE
Suffix:
Gender:M
Credentials:DA, LCSW, MLADC
Other - Prefix:DR
Other - First Name:N.
Other - Middle Name:WILLIAM
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DALCSW, MLADC
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NH
Mailing Address - Zip Code:03846-0155
Mailing Address - Country:US
Mailing Address - Phone:603-447-3329
Mailing Address - Fax:
Practice Address - Street 1:30 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818
Practice Address - Country:US
Practice Address - Phone:603-447-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)