Provider Demographics
NPI:1184454241
Name:WHITE, NICOLE RENEE (LAPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:ELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 MAIN ST STE 4F
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1632
Mailing Address - Country:US
Mailing Address - Phone:814-262-0025
Mailing Address - Fax:
Practice Address - Street 1:321 MAIN ST STE 4F
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1632
Practice Address - Country:US
Practice Address - Phone:814-254-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000267101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor