Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1043777378 |
---|---|
Provider Name | Dr. David S. White |
First Address | Loganville, GA 30052-3099 |
Second Address | Lilburn, GA 30047-7601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2019 |
Last Update Date | 22/02/2019 |