Provider Demographics
NPI:1306320635
Name:WHITE, JENNIFER E (MS, ALC, NCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 LEAHY CIR
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-3617
Mailing Address - Country:US
Mailing Address - Phone:256-375-5875
Mailing Address - Fax:
Practice Address - Street 1:65284 AL HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-3554
Practice Address - Country:US
Practice Address - Phone:256-375-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health