Provider Demographics
NPI:1689386617
Name:WHITE, LILA MAYE (BCBA)
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:MAYE
Last Name:WHITE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451B US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3397
Mailing Address - Country:US
Mailing Address - Phone:912-659-0202
Mailing Address - Fax:912-525-0377
Practice Address - Street 1:2451B US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3397
Practice Address - Country:US
Practice Address - Phone:912-656-0202
Practice Address - Fax:912-525-0377
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-22-61245103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst