Provider Demographics
NPI:1972354140
Name:WHITE, JEFF NICHOLAS (LPC)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:NICHOLAS
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 BLACKBERRY RUN TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-2131
Mailing Address - Country:US
Mailing Address - Phone:719-930-7844
Mailing Address - Fax:
Practice Address - Street 1:814 BLACKBERRY RUN TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-2131
Practice Address - Country:US
Practice Address - Phone:719-930-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional