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General NPI Number Information
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NPI Number | 1861856130
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Entity Type | Individual
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Provider Name | JAMES RYAN WHITE LPC
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Gender | Male
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 372 GREENO RD S
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City | FAIRHOPE
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State | AL
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Zip | 36532-1916
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Country | US
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Telephone | 251-928-9871
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Fax |
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Provider Business Mailing Address
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Address Line | 5750A SOUTHLAND DR
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City | MOBILE
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State | AL
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Zip | 36693-3316
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Country | US
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Telephone |
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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 | 3479
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License Number State | AL
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