Provider Demographics
NPI:1659397362
Name:WHITE, GEORGE M (LPC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:M
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:9844 LORI RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6691
Mailing Address - Country:US
Mailing Address - Phone:804-706-1111
Mailing Address - Fax:804-706-1185
Practice Address - Street 1:9844 LORI RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6691
Practice Address - Country:US
Practice Address - Phone:804-706-1111
Practice Address - Fax:804-706-1185
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010244765Medicaid