Provider Demographics
NPI:1841271285
Name:WHITE, VIRGINIA L (LMFT,LPC, CCS, CACII)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMFT,LPC, CCS, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVENUE STE 1D03
Mailing Address - Street 2:
Mailing Address - City:FT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-767-5260
Mailing Address - Fax:912-767-5271
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:SUITE 1D03
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5604
Practice Address - Country:US
Practice Address - Phone:912-767-5260
Practice Address - Fax:912-767-5271
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003757101YP2500X
DCLMFT000072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional