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NPI Code Detail

MEDICARE: TAKIEDRA WHITE LPC

MEDICARE: TAKIEDRA WHITE LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC009512GA
2101YM0800XMental Health CounselorLPC009512GA

General Provider Information

NPI Number : 1003256744
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAKIEDRA WHITE LPC
Provider Business Mailing Address
First Line : 1055 HOWELL MILL RD NW STE 800
Second Line :
City : ATLANTA
State : GA
Zip : 30318-5557
Country : US
Telephone Number : 404-692-6913
Fax Number :
Provider Business Practice Location Address
First Line : 1055 HOWELL MILL RD NW STE 800
Second Line :
City : ATLANTA
State : GA
Zip : 30318-5557
Country : US
Telephone Number : 404-692-6913
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2013
Last Update Date : 10/05/2023

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Directions to “ TAKIEDRA WHITE LPC” Practice Location

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