Provider Demographics
NPI:1114470317
Name:WHITE, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 BECK RD APT 1209
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2116
Mailing Address - Country:US
Mailing Address - Phone:313-574-6801
Mailing Address - Fax:
Practice Address - Street 1:8150 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-825-9700
Practice Address - Fax:586-825-9701
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010898221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical