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General NPI Number Information
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NPI Number | 1306502224
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Entity Type | Individual
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Provider Name | DEJON WHITE
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Gender | Female
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Dates
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Enumeration Date | 11/15/2021
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 6400 GROVEDALE DR STE 100
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2504
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Country | US
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Telephone | 571-290-0143
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 PROFESSIONAL PL STE 115
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City | LANDOVER
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State | MD
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Zip | 20785-2293
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Country | US
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Telephone | 866-727-8274
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-21-191021
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License Number State | DC
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