MEDICARE: DEJON WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	106S00000X	Behavior Technician	RBT-21-191021	DC

General Provider Information

NPI Number	:	1306502224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEJON WHITE

Provider Business Mailing Address
First Line	:	8200 PROFESSIONAL PL STE 115
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-2293
Country	:	US
Telephone Number	:	866-727-8274
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 GROVEDALE DR STE 100
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-2504
Country	:	US
Telephone Number	:	571-290-0143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	02/14/2022

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Directions to “ DEJON WHITE ” Practice Location

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