Provider Demographics
NPI:1962233346
Name:WHITE, CARLOS CORTEZ
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:CORTEZ
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3044
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-3044
Mailing Address - Country:US
Mailing Address - Phone:912-590-7120
Mailing Address - Fax:912-303-7143
Practice Address - Street 1:218 SCREVEN AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3452
Practice Address - Country:US
Practice Address - Phone:912-287-9134
Practice Address - Fax:912-303-7143
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral