Provider Demographics
NPI:1679620421
Name:WHITE, LAURA E (LPC, CEAP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:E
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2381 REDBUD TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6427
Mailing Address - Country:US
Mailing Address - Phone:901-210-1833
Mailing Address - Fax:
Practice Address - Street 1:5118 PARK AVE
Practice Address - Street 2:SUITE 525
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5720
Practice Address - Country:US
Practice Address - Phone:901-682-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001638101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional