Healthcare Provider Details

I. General information

NPI: 1134276686
Provider Name (Legal Business Name): BENJAMIN PARKER WHITE M.A. , PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BASS RD
MACON GA
31210-7301
US

IV. Provider business mailing address

500 BASS RD
MACON GA
31210-7301
US

V. Phone/Fax

Practice location:
  • Phone: 478-475-4608
  • Fax: 478-476-8397
Mailing address:
  • Phone: 478-475-4608
  • Fax: 478-476-8397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC000934
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT000384
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: