Individual
BRIAN WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
259 W MAIN ST, DECATURVILLE, TN 38329-8033
(731) 852-3112
(731) 852-3222
Mailing address
10710 OLD HIGHWAY 64, BOLIVAR, TN 38008-3587
(731) 658-6113
(731) 658-1597
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW 3864
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3925929
—
TN
01
—
4052001
BCBS PROVIDER NUMBER
TN
Enumeration date
08/29/2006
Last updated
05/06/2015
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