Provider Demographics
NPI:1760929863
Name:WHITE, TIMOTHY (TCADC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-5309
Mailing Address - Country:US
Mailing Address - Phone:502-964-7147
Mailing Address - Fax:502-964-2242
Practice Address - Street 1:8311 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5309
Practice Address - Country:US
Practice Address - Phone:502-964-7147
Practice Address - Fax:502-964-2242
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170586101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)