Provider Demographics
NPI:1790486355
Name:WHITE, LORI BARSTOW (MA, ALC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BARSTOW
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15491 WIRE RD
Mailing Address - Street 2:
Mailing Address - City:COALING
Mailing Address - State:AL
Mailing Address - Zip Code:35453-2631
Mailing Address - Country:US
Mailing Address - Phone:205-239-5674
Mailing Address - Fax:
Practice Address - Street 1:2112 HARGROVE RD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-2601
Practice Address - Country:US
Practice Address - Phone:205-462-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04382101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor