Provider Demographics
NPI:1558694042
Name:WHITE, WILLIAM JERRY JR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JERRY
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 S STATE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6188
Mailing Address - Country:US
Mailing Address - Phone:734-646-1086
Mailing Address - Fax:734-761-3884
Practice Address - Street 1:2750 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6179
Practice Address - Country:US
Practice Address - Phone:734-662-6300
Practice Address - Fax:734-662-3365
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010462071041C0700X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist