Provider Demographics
NPI:1982946737
Name:WHITE, LIZA
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5027 PEACH MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-1423
Mailing Address - Country:US
Mailing Address - Phone:502-599-4747
Mailing Address - Fax:
Practice Address - Street 1:3138 BRACHENBURY LANE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-1037
Practice Address - Country:US
Practice Address - Phone:502-599-4747
Practice Address - Fax:502-589-8771
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health