Provider Demographics
NPI:1891218590
Name:WHITE, NIESHA NIQUAN (LPC)
Entity Type:Individual
Prefix:
First Name:NIESHA
Middle Name:NIQUAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 PINER RD
Mailing Address - Street 2:SUITE A # 551
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409
Mailing Address - Country:US
Mailing Address - Phone:704-723-1571
Mailing Address - Fax:910-338-5637
Practice Address - Street 1:118 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4952
Practice Address - Country:US
Practice Address - Phone:910-632-0011
Practice Address - Fax:910-338-5637
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13111101Y00000X, 101YP2500X, 101YM0800X
NCA13111101YM0800X, 101YP2500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health