Provider Demographics
NPI:1376503797
Name:WHITE, TERRELL HILDA
Entity Type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:HILDA
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8003
Mailing Address - Country:US
Mailing Address - Phone:803-255-3417
Mailing Address - Fax:803-255-3451
Practice Address - Street 1:15 MEDICAL PARK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8003
Practice Address - Country:US
Practice Address - Phone:803-434-4300
Practice Address - Fax:803-255-3451
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC129672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC129676Medicaid
D79071Medicare UPIN