Provider Demographics
NPI:1922830231
Name:WHITE, TYKERIA (MFT)
Entity type:Individual
Prefix:
First Name:TYKERIA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:TY
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:4007 CREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-8123
Mailing Address - Country:US
Mailing Address - Phone:229-305-2885
Mailing Address - Fax:
Practice Address - Street 1:3205 S CHEROKEE LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5401
Practice Address - Country:US
Practice Address - Phone:770-300-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist