Provider Demographics
NPI:1841338837
Name:WHITE, TRISTIN LORRAINE (PHD, LCMHCS, LPC)
Entity type:Individual
Prefix:DR
First Name:TRISTIN
Middle Name:LORRAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD, LCMHCS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 RIKER ST
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-6723
Mailing Address - Country:US
Mailing Address - Phone:980-259-2061
Mailing Address - Fax:
Practice Address - Street 1:508 BETHEL ST
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-1154
Practice Address - Country:US
Practice Address - Phone:803-675-8227
Practice Address - Fax:704-919-5079
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1014101YA0400X
SC338101YA0400X
NC4518101YP2500X
WALH60613218101YP2500X
SC6722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102839Medicaid