MEDICARE: NISSA CHRISTINA WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1427825	GA

General Provider Information

NPI Number	:	1598371304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISSA CHRISTINA WHITE

Provider Business Mailing Address
First Line	:	3520 PIEDMONT RD NE STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-1512
Country	:	US
Telephone Number	:	404-351-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 PIEDMONT RD NE STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-1512
Country	:	US
Telephone Number	:	404-351-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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Directions to “ NISSA CHRISTINA WHITE ” Practice Location

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