Provider Demographics
NPI:1114022993
Name:WHITE, D'JARIS RENEE (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:D'JARIS
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:DR
Other - First Name:D'JARIS
Other - Middle Name:R
Other - Last Name:COLES-WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH,D, CCC-SLP
Mailing Address - Street 1:6732 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1760
Mailing Address - Country:US
Mailing Address - Phone:678-901-7788
Mailing Address - Fax:
Practice Address - Street 1:6732 SPRING ST
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1760
Practice Address - Country:US
Practice Address - Phone:678-901-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist