Healthcare Provider Details

I. General information

NPI: 1902134919
Provider Name (Legal Business Name): KOLBIE MICHELLE WHITE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 E ELM ST
ATHENS AL
35611-5318
US

IV. Provider business mailing address

1316 SOMERVILLE RD SE SUITE 1
DECATUR AL
35601-4305
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-6105
  • Fax:
Mailing address:
  • Phone: 256-355-6105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05096
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: