Provider Demographics
NPI:1417314519
Name:WHITE, PERCY RODRIDIQUIES SR (MA, LCMHC, LCAS, NCC)
Entity Type:Individual
Prefix:MR
First Name:PERCY
Middle Name:RODRIDIQUIES
Last Name:WHITE
Suffix:SR
Gender:M
Credentials:MA, LCMHC, LCAS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6518 BONNIE BELL LANE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314
Mailing Address - Country:US
Mailing Address - Phone:910-574-4984
Mailing Address - Fax:
Practice Address - Street 1:6518 BONNIE BELL LANE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314
Practice Address - Country:US
Practice Address - Phone:910-574-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22068101YA0400X
NC11671101YM0800X
NCA11671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)