Healthcare Provider Details

I. General information

NPI: 1386138469
Provider Name (Legal Business Name): THE WHYTE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 ESTATE THOMAS STE 105
ST THOMAS VI
00802-2612
US

IV. Provider business mailing address

11687 FLEMMING CT
HAMPTON GA
30228-3455
US

V. Phone/Fax

Practice location:
  • Phone: 678-612-4948
  • Fax:
Mailing address:
  • Phone: 678-612-4948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA B WHYTE
Title or Position: OWNER
Credential: NCMHC
Phone: 678-612-4948