Provider Demographics
NPI:1376156596
Name:WHITE, JENNIFER MARCIA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARCIA
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 1:2003 CASCADE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3776
Mailing Address - Country:US
Mailing Address - Phone:517-879-6611
Mailing Address - Fax:
Practice Address - Street 1:207 1ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2102
Practice Address - Country:US
Practice Address - Phone:517-998-4673
Practice Address - Fax:517-998-4673
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health