Provider Demographics
NPI:1104845965
Name:WHITE, NINA A (PHD,LMHC,LPC,NCC)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD,LMHC,LPC,NCC
Other - Prefix:DR
Other - First Name:N.
Other - Middle Name:A
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-1111
Mailing Address - Country:US
Mailing Address - Phone:678-838-8333
Mailing Address - Fax:
Practice Address - Street 1:8303 OFFICE PARK DR
Practice Address - Street 2:B
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6935
Practice Address - Country:US
Practice Address - Phone:678-838-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007084101YP2500X
FLLMH6619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health