Provider Demographics
NPI:1922473347
Name:WHITE, TANYA (LPC NCC)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 WEBB BRIDGE RD UNIT 4651
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30023-0506
Mailing Address - Country:US
Mailing Address - Phone:770-415-3442
Mailing Address - Fax:
Practice Address - Street 1:4575 WEBB BRIDGE RD UNIT 4651
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30023-0506
Practice Address - Country:US
Practice Address - Phone:770-415-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC 6574101YM0800X
GALPC005475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003178816AMedicaid
GA1922473347Medicaid