Susan White, LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C011047 Issued in NC

Practice address

504 Walters Dr
Wake Forest, NC 27587-6177

Phone

(804) 426-6810

NPI assigned

Apr 24, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 26, 2024 through Jan 26, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Foundations Family Therapy of North Carolina, PLLC

  • Community/Behavioral Health Agency
  • Fuquay Varina, NC
  • NPI 1366793895
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1780172890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 WALTERS DR",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876177",
            "telephone_number": "804-426-6810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 WALTERS DR",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876177",
            "telephone_number": "804-426-6810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-24",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C011047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Bradley Whicker
• Crystal Mitchell White, PHARMD
• Phillip White
• Phillip Anthony White II, LCSWA
• Sasha White, LPC
• Barry Whitehead, M.S., CCC-SLP
• Jodi Nicole Whiteman, M.ED.
• Makenzie Whitley, DNP, FNP-C
• Clairissa Monique Whitted, LCMHCA
• Wholeness Counseling & Wellness PLLC

• Clinical Social Worker in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.