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General NPI Number Information
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NPI Number | 1003433558
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Entity Type | Individual
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Provider Name | KEISHA L WHITE ED.S, NCC,LAPC
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Gender | Female
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 500 LANIER AVE W STE 103B
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7640
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Country | US
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Telephone | 404-800-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 6873 SLATE STONE WAY SE
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City | MABLETON
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State | GA
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Zip | 30126-5433
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Country | US
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Telephone | 404-914-8005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | APC007240
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License Number State | GA
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