Basic Information
| Provider Information | |||||||||
| NPI: | 1033520879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | JILL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E MCBEE AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8646956065 | ||||||||
| FaxNumber: | 7196341874 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 PATEWOOD DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296156317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644558988 | ||||||||
| FaxNumber: | 8645225555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2014 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3091 | TN | N | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 1137 | CO | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 7062 | SC | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.