Provider Demographics
NPI:1073851564
Name:WHITE, SHANICE N (LPC-S, NCC)
Entity Type:Individual
Prefix:
First Name:SHANICE
Middle Name:N
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 GLENNOAK DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9384
Mailing Address - Country:US
Mailing Address - Phone:601-613-6268
Mailing Address - Fax:
Practice Address - Street 1:4038 GLENNOAK DR
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9384
Practice Address - Country:US
Practice Address - Phone:601-613-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1877101Y00000X
GALPC011614101Y00000X
MS2737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS003508069Medicaid