Provider Demographics
NPI:1285979468
Name:WHITE, TERRI L (LPC)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:L
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 1:3932 PLYMOUTH ROCK DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2513
Mailing Address - Country:US
Mailing Address - Phone:678-622-2508
Mailing Address - Fax:
Practice Address - Street 1:230 S CULVER ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4806
Practice Address - Country:US
Practice Address - Phone:678-883-8609
Practice Address - Fax:678-559-0409
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional