=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689480709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHONDA GAIL WHITE ALC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2024
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 557 GLOVER AVE STE 3
-----------------------------------------------------
City | ENTERPRISE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36330-2070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-308-2292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8658 COUNTY ROAD 636
-----------------------------------------------------
City | CHANCELLOR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36316-7090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-806-1591
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------