Provider Demographics
NPI:1942978739
Name:WHITE, MICHAEL ANTHONY SR (MSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:WHITE
Suffix:SR
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:ANTHONY
Other - Last Name:WHITE
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4311 SCHOOL HOUSE CMNS # 140
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7510
Mailing Address - Country:US
Mailing Address - Phone:704-918-5494
Mailing Address - Fax:
Practice Address - Street 1:4311 SCHOOL HOUSE CMNS # 140
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7510
Practice Address - Country:US
Practice Address - Phone:704-918-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0167591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty