Provider Demographics
NPI:1104845965
Name:WHITE, NINA (PHD, LPC, LMHC, NCC)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD, LPC, LMHC, NCC
Other - Prefix:DR
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC, LMHC, NCC
Mailing Address - Street 1:PO BOX 1018
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-1018
Mailing Address - Country:US
Mailing Address - Phone:470-567-9191
Mailing Address - Fax:404-905-6336
Practice Address - Street 1:4813 RIDGE RD STE 113
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6120
Practice Address - Country:US
Practice Address - Phone:470-567-9191
Practice Address - Fax:404-905-6336
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2025-10-17
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