Provider Demographics
NPI:1447008487
Name:WHITE, AMANDA SUMER (P-LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUMER
Last Name:WHITE
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 MORRISTON RD
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-5202
Mailing Address - Country:US
Mailing Address - Phone:601-606-8908
Mailing Address - Fax:
Practice Address - Street 1:525 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-3954
Practice Address - Country:US
Practice Address - Phone:601-606-8908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional