Healthcare Provider Details

I. General information

NPI: 1386841153
Provider Name (Legal Business Name): TRACELA MICHELLE WHITE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PEACHTREE ST NW SUITE 770
ATLANTA GA
30303-2316
US

IV. Provider business mailing address

1107 E UPSAL ST APT. 1
PHILADELPHIA PA
19150-2601
US

V. Phone/Fax

Practice location:
  • Phone: 912-557-7001
  • Fax:
Mailing address:
  • Phone: 215-548-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License NumberPS015143
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003238
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: