Healthcare Provider Details

I. General information

NPI: 1538992763
Provider Name (Legal Business Name): MARIA ANGELA WHITE LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 EMMORTON RD STE 201
BEL AIR MD
21015-6180
US

IV. Provider business mailing address

2015 EMMORTON RD STE 201
BEL AIR MD
21015-6180
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone: 410-800-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP14812
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: