Active NPI
Jeff Nicholas White, LPC
- Professional Counselor
- Dallas, GA
National Provider Identifier
1972354140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 014061
- Practice address
- 814 Blackberry Run TRL
Dallas, GA 30132-2131 - Phone
- (719) 930-7844
- NPI assigned
- Mar 27, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 014061 | GA | Primary |
Addresses
Primary practice location
814 Blackberry Run TRL
Dallas, GA 30132-2131
Mailing address
814 Blackberry Run TRL
Dallas, GA 30132-2131
Phone (719) 930-7844
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 29, 2024 through Mar 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014061 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712880000000",
"number": "1972354140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 BLACKBERRY RUN TRL",
"city": "DALLAS",
"state": "GA",
"postal_code": "301322131",
"telephone_number": "719-930-7844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "814 BLACKBERRY RUN TRL",
"city": "DALLAS",
"state": "GA",
"postal_code": "301322131",
"telephone_number": "719-930-7844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "JEFF",
"middle_name": "NICHOLAS",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-27",
"last_updated": "2024-04-12",
"certification_date": "2024-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "014061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.