Provider Demographics
NPI:1811681828
Name:WHITE, STEFAN JAMES (RBT)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:JAMES
Last Name:WHITE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 NW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-1445
Mailing Address - Country:US
Mailing Address - Phone:305-834-5125
Mailing Address - Fax:
Practice Address - Street 1:5461 HILLANDALE DR STE 100
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4842
Practice Address - Country:US
Practice Address - Phone:470-361-2976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-272472106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician