MEDICARE: AMY J. WHITE, LCPC & ASSOCIATES PC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	499	MD
2	101YM0800X	Mental Health Counselor	LC2138	MD

General Provider Information

NPI Number	:	1568829620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY J. WHITE, LCPC & ASSOCIATES PC

Provider Business Mailing Address
First Line	:	2931F OLNEY SANDY SPRING ROAD
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832
Country	:	US
Telephone Number	:	301-775-9661
Fax Number	:	301-830-6862

Provider Business Practice Location Address
First Line	:	2931 OLNEY SANDY SPRING RD STE F
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-1579
Country	:	US
Telephone Number	:	301-775-9661
Fax Number	:	301-830-6862

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	AMY JO WHITE
Credential	:	LCPC
Telephone Number	:	301-775-9661

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	01/20/2016

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