Healthcare Provider Details

I. General information

NPI: 1952124281
Provider Name (Legal Business Name): VICTORIA JULIA-EGLAH WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 ANNAPOLIS RD
LANHAM MD
20706-3115
US

IV. Provider business mailing address

12007 QUARTETTE LN
BOWIE MD
20720-4355
US

V. Phone/Fax

Practice location:
  • Phone: 240-296-5848
  • Fax:
Mailing address:
  • Phone: 240-595-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: