=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336473602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AT THE TABLE COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2009
-----------------------------------------------------
Last Update Date | 09/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 VALLEY VIEW LN STE 338
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75062-1776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-684-5867
-----------------------------------------------------
Fax | 214-393-4793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 VALLEY VIEW LN STE 338
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75062-1776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-684-5867
-----------------------------------------------------
Fax | 214-393-4793
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | SONEAKQUA WHITE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 214-684-5867
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 20024
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------