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General NPI Number Information
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NPI Number | 1942929781
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Entity Type | Individual
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Provider Name | CLINTON WHITE
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Gender | Male
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 2527 MCGILL ST # 202
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City | PIGEON FORGE
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State | TN
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Zip | 37863-4263
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Country | US
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Telephone | 865-830-6792
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4038
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City | SEVIERVILLE
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State | TN
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Zip | 37864-4038
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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 | 4392
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License Number State | TN
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