Provider Demographics
NPI:1821303157
Name:WHITE, MICHAEL A (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15701 COUNTY ROAD K
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530
Mailing Address - Country:US
Mailing Address - Phone:608-776-4800
Mailing Address - Fax:608-776-4890
Practice Address - Street 1:15701 COUNTY ROAD K
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530
Practice Address - Country:US
Practice Address - Phone:608-776-4800
Practice Address - Fax:608-776-4890
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7162101YP2500X
IL180011345101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional