Provider Demographics
NPI:1609229475
Name:WHITE, TYHESCIA (LPC)
Entity Type:Individual
Prefix:
First Name:TYHESCIA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TYHESCIA
Other - Middle Name:
Other - Last Name:WHITE-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:305 W SPRING ST
Mailing Address - Street 2:POST OFFICE BOX 172
Mailing Address - City:MOUNT VERNON
Mailing Address - State:GA
Mailing Address - Zip Code:30445-2837
Mailing Address - Country:US
Mailing Address - Phone:912-423-0498
Mailing Address - Fax:912-583-0115
Practice Address - Street 1:305 W SPRING ST
Practice Address - Street 2:POST OFFICE BOX 172
Practice Address - City:MOUNT VERNON
Practice Address - State:GA
Practice Address - Zip Code:30445-2837
Practice Address - Country:US
Practice Address - Phone:912-423-0498
Practice Address - Fax:912-583-0115
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health