Provider Demographics
NPI:1396075230
Name:WHITE, WILLIAM C (LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:WHITE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ROSWELL FARMS DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4367
Mailing Address - Country:US
Mailing Address - Phone:404-599-4609
Mailing Address - Fax:
Practice Address - Street 1:395 PRYOR ST SW
Practice Address - Street 2:SUITE 2142
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2713
Practice Address - Country:US
Practice Address - Phone:404-613-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0050431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical