Provider Demographics
NPI:1972149391
Name:WHITE, STELLA MARIE MCCLAINE (LPC)
Entity type:Individual
Prefix:
First Name:STELLA MARIE
Middle Name:MCCLAINE
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 1:2031 WITHERS RD
Mailing Address - Street 2:
Mailing Address - City:DU PONT
Mailing Address - State:GA
Mailing Address - Zip Code:31630-3741
Mailing Address - Country:US
Mailing Address - Phone:912-520-0200
Mailing Address - Fax:
Practice Address - Street 1:2031 WITHERS RD
Practice Address - Street 2:
Practice Address - City:DU PONT
Practice Address - State:GA
Practice Address - Zip Code:31630-3741
Practice Address - Country:US
Practice Address - Phone:912-520-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional