Provider Demographics
NPI:1295864213
Name:WHITE, ROZELLE FREDRICK (CAC-1)
Entity Type:Individual
Prefix:MR
First Name:ROZELLE
Middle Name:FREDRICK
Last Name:WHITE
Suffix:
Gender:M
Credentials:CAC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3357 JACQUE ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3711
Mailing Address - Country:US
Mailing Address - Phone:810-233-4976
Mailing Address - Fax:810-233-4976
Practice Address - Street 1:901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1570
Practice Address - Country:US
Practice Address - Phone:810-232-9950
Practice Address - Fax:810-232-7599
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-03938101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)