Provider Demographics
NPI:1841479821
Name:SPITZNAGEL WHITE, MARY JO (LPC, CRC)
Entity type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:SPITZNAGEL WHITE
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 THE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6284
Mailing Address - Country:US
Mailing Address - Phone:407-716-6988
Mailing Address - Fax:
Practice Address - Street 1:10 WILSON RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4468
Practice Address - Country:US
Practice Address - Phone:770-506-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional