Provider Demographics
NPI:1467897728
Name:BAKER-WHITE, EBONY STAR (MA,LPC,CAMS)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:STAR
Last Name:BAKER-WHITE
Suffix:
Gender:F
Credentials:MA,LPC,CAMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 ALEXANDER STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-7205
Mailing Address - Country:US
Mailing Address - Phone:404-597-9910
Mailing Address - Fax:888-908-7984
Practice Address - Street 1:316 ALEXANDER STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-7205
Practice Address - Country:US
Practice Address - Phone:404-597-9910
Practice Address - Fax:888-908-7984
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007289101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health