Provider Demographics
NPI:1770840076
Name:WHITE, ERIN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-1325
Mailing Address - Country:US
Mailing Address - Phone:615-318-4810
Mailing Address - Fax:615-215-2135
Practice Address - Street 1:109 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-1325
Practice Address - Country:US
Practice Address - Phone:615-318-4810
Practice Address - Fax:615-215-2135
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW58451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532320Medicaid
TN103I802065OtherMEDICARE PTAN
TN4863894OtherCIGNA
TN473055030OtherVALUE OPTIONS/TRICARE
TN6035947OtherBLUE CROSS BLUE SHIELD
TN6035947OtherMAGELLAN